tci Medicare Compliance & Reimbursement - 2008 Issue 38

Reader Question: Don't Risk Pay! Verify The Location For Synvisc Coding

Caution: Some payers only reimburse these injections to the knee, while others might pay for the hip or ankle. Question: Which diagnosis should I report to support Synvisc administration? Answer: Diagnosis coding possibilities for the knee include 715.1x (Osteoarthrosis, localized, primary), but 715.3x (Osteoarthrosis, localized, not specified whether primary or secondary) is usually the go-to code because physicians do not typically state whether the osteoarthrosis is localized, primary or localized, secondary. You could also look at 715.16 (Osteoarthrosis, localized, primary; lower leg), 715.26 (Osteoarthrosis, localized, secondary; lower leg), 715.36 (Osteoarthrosis, localized, not specified whether...

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