Coding Corner Answer

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99214-25, 20610, J7325 x 48 with a diagnosis of 715.96, 787.02.

This encounter is coded as 99214 because it included:

• A detailed history—an extended history of present illness, an extended review of systems, and one past family and social history;
• A comprehensive examination—eight systems; and
• Medical decision making—moderate complexity (established problem worsening, new problem with additional workup [the injection]; prescription drug management)

The code 20610 would be used for the intraarticular injection of the right knee.

Note: The office visit is allowed because the knee injection was a separate and significant problem the patient presented at the time of the visit.

*This injection could be denied for not meeting necessity. The medical policy for this carrier states that “at least six months have elapsed since the prior series of injections.”