- D—As of January 2015, there are three new codes added to the arthrocentesis codes of 20600–20611. The new codes, 20604, 20606 and 20611, should be reported when the procedure is performed with ultrasound guidance and CPT 76942 should not be billed separately. The three new codes are defined as:
- 20604—Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); with ultrasound guidance, with permanent recording and reporting;
- 20606—Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting; and
- 20611—Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.
- B—In ICD-10 documentation, M15.0 primary generalized osteoarthritis contains an Excludes 1 guideline of bilateral involvement of single joint (M16–M19). An Excludes 1 note generally means those two codes cannot be used for the same visit.
- B—The only comorbidities that should be coded during each encounter are the ones assessed during that visit. If the patient has a comorbidity that affects the treatment for that date of service, then there must be documentation that the comorbidity was addressed and assessed, even if it is simply stated that the patient was instructed to follow up with their primary care physician.
- B—Even though the history and examination were comprehensive, the nature of the presenting problem and the medical decision making do not support the medical decision making. The medical necessity for performing the key components of history and exam is determined by the nature of the presenting problem. This is formed from the patient’s own personal history in conjunction with the clinical judgment of the provider for evidence-based medical care. The evidence of this is found in the documentation of the medical decision making.
- B—In order for services completed by a midlevel provider to be reimbursed as incident to, two criteria must be met. The services must be for an established patient with an established diagnosis. If either of these two criteria is not met, then there are two choices in how to bill the services:
- A midlevel provider can see an established patient with a new problem, but this cannot be billed as incident to. Unless the supervising provider assesses and documents the new problem, then this visit will be billed under the midlevel’s national provider identification number and receive only 85% of the Medicare Part B Physician Fee Schedule.
- The note had no documentation of the supervising physician assessment or treatment plan.
- A midlevel provider can see a new patient, but the visit cannot be billed as incident to. It will have to be billed under the midlevel’s national provider identification number and receive only 85% of the Medicare Part B Physician Fee Schedule.
- A midlevel provider can see an established patient with a new problem, but this cannot be billed as incident to. Unless the supervising provider assesses and documents the new problem, then this visit will be billed under the midlevel’s national provider identification number and receive only 85% of the Medicare Part B Physician Fee Schedule.
For questions or more information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, at [email protected] or 404-633-3777 x820.
