ICD-10: M17.12, E66.01, Z68.41
Coding/Billing Rationale
No evaluation and management (E/M) code was added because there was no significant and/or separate identifiable reason for an E/M service to be billed with this scheduled visit for her series of injections. The joint injection was billed with ultrasound guidance due to the patient’s weight and flexion of her knee.
The modifier LT specifies to the payer that the left knee was injected. The EJ modifier is used to indicate this is a series of injections. The EJ modifier is required by Medicare for subsequent claims for a defined course of therapy (e.g., sodium hyaluronate, infliximab). Keep in mind, this modifier is purely informational for Medicare use and may be submitted with many HCPCS J-codes for injections. Because the EJ modifier is informational only, the practice must submit it after any other appropriate modifiers, but it must be in the last modifier position on the CMS-1500 form. Practices should verify with their individual Medicare Administrative Contractor policies how to bill with this modifier to avoid unnecessary denials or audits.
The diagnosis codes were: M17.12 for unilateral primary osteoarthritis of the left knee; E66.01 for morbid (severe) obesity due to excess calories; and Z68.41 for the body mass index of an adult of 40.0–44.9.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at [email protected] or call 404-633-3777 x820.
