Joint Aspiration/Injection Coding

During either joint aspiration or injection, imaging guidance may be employed to ensure accurate needle placement. In 2015, CPT® revised existing joint (or bursa) aspiration/injection codes to specify “without ultrasonic guidance,” while adding codes to describe the same procedures with ultrasonic (US) guidance:

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 US guidance, select 20604, 20606, or 20611 (depending on the joint targeted). If the provider aspirates/injects the joint/bursa without guidance of any kind, select from among 20600, 20605, and 20610.

Reporting Multiple Units

Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint.
You may report multiple units of a single code for aspiration/injection of multiple joints of same size. (e.g., two large joints, left knee and left shoulder). If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), report one unit of 20610 with modifier 50 Bilateral procedure appended, per Centers for Medicare & Medicaid (CMS) instruction. Non-Medicare payers may specify different methods to indicate a bilateral procedure.
If the provider performs injections on separate, non-symmetrical joints (e.g., left shoulder and right knee), report two units of the aspiration/injection code and append modifier 59 Distinct procedural service to the second unit (e.g., 20610, 20610-59).

Some Guidance May Be Separate

CPT® allows you to separately report fluoroscopic, CT, or MRI guidance for needle placement during joint/bursa aspiration/injection, when performed. Claim the “without ultrasonic guidance” code for the aspiration/injection, plus 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, or 70021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation, as appropriate.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering 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.

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