How to Report Imaging Guidance with Small Joint Injection

How to Report Imaging Guidance with Small Joint Injection

During either aspiration or injection, imaging guidance may be employed to ensure accurate needle placement. In 2015, the AMA revised previous joint (or bursa) aspiration/injection codes to specify “without ultrasonic guidance,” while adding codes to describe the same procedures with ultrasonic (US) 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: You will 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 report the US guidance (e.g., 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) separately because it is 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 among 20600, 20605, and 20610. For example, if the injection in the above example had occurred without any guidance, report 20610.

You May Separately Report Guidance Other Than US

Per CPT® instructions, you may separately report fluoroscopic, CT, or MRI imaging 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, you would 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 imaging guidance, the proper coding is 20610, 77012.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 402 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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