The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Rheumatology Coding Corner Answer: Follow-Up Knee Injection

Rheumatology Coding Corner Answer: Follow-Up Knee Injection

March 19, 2018 • By From the College

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Take the challenge.

You Might Also Like
  • Rheumatology Coding Corner Answer: Bilateral Knee Injections
  • Rheumatology Coding Corner Answer: Coding for a Knee Injection
  • Rheumatology Coding Corner Answer: Coding for a Knee Injection
Explore This Issue
March 2018
Also By This Author
  • ACR Releases COVID-19 Clinical Guidance for Pediatric Patients

CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2
ICD-10: M17.0

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Coding Rationale
CPT Codes: 20610-LT, J7325x16
ICD-10 Code: M17.12

This claim is rejected by the insurance carrier because the injection was outside of the preauthorization window that ended on Oct. 31. Most insurance carriers enforce their preauthorization dates for procedures. In some cases, they will not reimburse a claim if it is only one day outside of the end date of the preauthorization, which can be a financial burden for practices. Do not assume a preauthorization is from January to December; that may not be the case, and it is based on the decision of the payer. There should be a review of every preauthorization to determine how many times a procedure is allowed and the allowed window of time.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Even if the preauthorization was correct, the only thing acceptable to code is the injection itself. The practice staff knew this patient was coming in for the injection. There is nothing in the patient’s history that indicates a need for an evaluation and management visit along with the injection.

The ICD-10 code is for the unilateral primary osteoarthritis of the left knee.

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.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Filed Under: Billing/Coding, From the College, Practice Management Tagged With: Billing & Coding, Knee Osteoarthritis (OA), preauthorization, prior authorizationIssue: March 2018

You Might Also Like:
  • Rheumatology Coding Corner Answer: Bilateral Knee Injections
  • Rheumatology Coding Corner Answer: Coding for a Knee Injection
  • Rheumatology Coding Corner Answer: Coding for a Knee Injection
  • Rheumatology Coding Corner Answer: Joint Injection with Ultrasound Guidance, No Office Visit

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)