Infected Knee

Question:

Will you please direct this question to Mary LeGrand? I was consulted to evaluate a patient to rule out a septic knee. I saw the patient in the morning and aspirated the joint; the fluid was cloudy and sent to pathology. Later that day I was notified of an increased cell count and decided to take the patient to the OR later that day for an arthrotomy with lavage. My coder is telling me that I cannot bill CPT code 20610 with the arthrotomy because of a Medicare payment edit. This makes no sense to me. Can you advise if I am able to report this aspiration or not?

Answer:

Thanks for your inquiry. Yes, the aspiration is reportable with CPT code 20610 as you note. You may also report the arthrotomy with knee lavage; for example, CPT code 27310. Your coder is correct in that an NCCI edit is present between the two codes when performed on the same knee, same session. However, in your scenario, they are performed same day, different sessions. Append a modifier 59 (distinct procedure) to CPT code 20610 to indicate the aspiration occurred at a different session on the same day. If your Medicare carrier has instructed to use the new “X” modifiers instead of modifier 59 to indicate the “separate encounter,” you would report 20610 XE instead of 20610-59.

Your service will be reported one of two ways:2731020610-59Or2731020610 XE

*This response is based on the best information available as of 10/08/15.