Coding for Joint Aspiration and Injection

During either joint aspiration or injection, imaging guidance may be employed to ensure accurate needle placement. For CPT® 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:

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, 20604shoulder, 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. Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint.

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 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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