Sharpen Your Joint Aspiration/Injection Coding
- By Renee Dustman
- In Industry News
- February 1, 2015
- Comments Off on Sharpen Your Joint Aspiration/Injection Coding
CPT® 2015 requires you to differentiate “with” or “without” ultrasonic guidance.
By G.J. Verhovshek, MA, CPC
Among the many hundreds of changes to the 2015 CPT® codebook are new and revised codes to report aspiration or injection of small, medium, and large joints. Combination codes now describe such aspiration/injection with ultrasonic (US) guidance, but allow for separate reporting when other types of imaging are performed for needle placement.
Aspiration and Injection
Are “Different but the Same”
Aspiration is the removal of fluid, while injection generally entails the introduction of a fluid. Aspiration typically occurs to collect fluid for diagnostic analysis, or to provide drainage of an effusion to provide pain relief and improve joint mobility. Injection of a drug into the joint likewise may yield symptoms relief. Although the procedures are “opposites,” the process of inserting a needle into the joint is identical; joint aspirations and joint injections are reported using the same set of codes.
US Guidance Now a Factor in Code Selection
During either aspiration or injection, imaging guidance may be employed to ensure accurate needle placement. For 2015, the American Medical Association (AMA) has revised previous joint (or bursa) aspiration/injection codes (which continue to categorize joints by size) to specify “without ultrasound guidance,” while adding codes to describe the same procedures “with ultrasound guidance” (revised text is underlined):
20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting
20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting
20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance
20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting
If the provider performs joint aspiration/injection with the aid of US guidance, code application is straightforward: Select 20604, 20606, or 20611, depending on the joint targeted.
Example: Using US guidance for precise needle placement, the provider injects bupivacaine into the knee joint for pain management. Because the knee is defined as a major joint, the correct code is 20611. You would not separately report the US guidance (e.g., 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) because it’s an inclusive component of the primary procedure.
If the provider aspirates/injects the joint/bursa without guidance of any kind, coding is equally straightforward: Select from 20600, 20605, and 20610. For example, if the injection in the above example occurred without any guidance, the correct code is 20610.
You May Separately Report Guidance Other than US
Per CPT® instructions, you may separately report fluoroscopic, computed tomography (CT), or magnetic resonance imaging (MRI) guidance for needle placement during joint/bursa aspiration/injection.
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
In such a case, report the “without ultrasonic guidance” code for the aspiration/injection, as well as 77002, 77012, or 70021, as appropriate.
For example, if the provider injects bupivacaine into the knee joint for pain management using CT guidance, the proper coding is 20610, 77012.
G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Asheville-Hendersonville, North Carolina, local chapter.
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Can a PA or a PAC provide and bill the new ultrasound codes?
If a steroid injection of two joints (1=Metacarpophalangeal and 1=interphalangeal ) in one finger on the same hand. Can that be reported as two Asp/Inj Small Jnt/Bur w US guidance (20604, 20604-XS)?