While questioned by many providers, the Medicare CCI edits currently bundles CPT 62310, Injection, single not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s), epidural or subarachnoid; cervical or thoracic into CPT 20550, Injection(s);single tendon sheath, or ligament¸ aponeurosis (eg, plantar” fascia”).
Medicare’s correct coding modifier indicator (1) allows for a modifier (i.e., -59 when applicable) to be appended to CPT 62310 when performed at a separate and distinct anatomical location/region than the injection reported by CPT 20550.
According to the National Correct Coding Initiative, “Carrier processing systems utilize NCCI-associated modifiers to allow payment of both codes of an edit. Modifier -59 and other NCCI associated modifiers should NOT be used to bypass an NCCI edit unless the proper criteria for use of the modifier is met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier used.” Source: www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf (pdf)
Coding tip: When considering code determination, the physician’s documentation should detail the specific injections and separate/distinct anatomic locations/regions he is entering and/or injecting as well as the medical necessity for each injection(s).
- If determined that detailed documentation does support separate/distinct injection procedures, two injection codes may be reported.
Correct code — CPT 62310-59 = $295.98; CPT 20550 = $19.30 approximate reimbursement by Medicare
- If determined that documentation does not support separate and distinct anatomic locations/regions for the two injections performed, only one injection can be reported.
Correct code — CPT 20550 = $19.30 approximate reimbursement by Medicare
Note: If documentation is deficient, it is strongly recommended to query the physician for clarification.
Cristina Bentin can be reached at cristina@ccmpro.com. Learn more about Coding Compliance Management.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
