Coding Arthrocentesis, Aspiration, or Injection Is a Joint Effort
- By Guest Contributor
- In Healthcare Business Monthly
- November 1, 2017
- 2 Comments
Utilize all the code sets, plus modifiers, to wholly capture physicians’ services.
By Dawson Ballard, Jr., CPC, CPC-P, CEMC, CPMA, CRHC, CCS-P
Coding for joint arthrocentesis, aspiration, or injection can be difficult, but following a few simple rules and pulling your coding resources together can make it easier.
CPT® Categorizes Codes
Arthrocentesis, aspiration, or injection is the process of inserting a needle into a joint or bursa to inject medication, or aspirate fluid for diagnosis or pressure relief. CPT® codes for these procedures are 20600-20615.
CPT® categorizes the codes based on the type of joint or bursa, and whether ultrasound guidance is performed. Report arthrocentesis, aspiration, or injection on:
Small joints or bursa — such as the fingers or toes — using 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance, or 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting.
Intermediate joints or bursa — such as temporomandibular, acromioclavicular, wrist, elbow, ankle or olecranon bursa — using 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance, or 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.
Major joints or bursa — such as the shoulder, hip, knee, or subacromial bursa — using 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance, or 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.
Per CPT® guidance, do not report 20600, 20604, 20605, and 20606 with 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation. Also, do not report 20610 and 20611 with 27370 Injection of contrast for knee arthrography or 76942. If fluoroscopic, computed tomography (CT), or magnetic resonance imaging (MRI) guidance is performed, also report the appropriate radiology code, such as:
+77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)
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
Cyst Treatments Have Their Own Codes
CPT® also provides codes for aspiration and/or injection into a ganglion cyst or for treatment of a bone cyst. For a ganglion cyst treatment, report 20612 Aspiration and/or injection of ganglion cyst(s) any location, regardless of the location. For multiple ganglion cysts, report 20612 and append modifier 59 Distinct procedural service.
For bone cyst treatment, report 20615 Aspiration and injection for treatment of bone cyst.
Additional Services May Be Payable
When reporting these procedures, pay close attention to the description of the codes. For example, 20610 specifies “arthrocentesis, aspiration, and/or injection of a major joint or bursa.” Per CPT® guidance, if an aspiration is performed on a major joint/bursa, and an injection is performed immediately following the aspiration on the same major joint/bursa, report 20610 one time. If the procedure is performed on multiple joints, report separate codes for each joint. If medication is injected, report the appropriate HCPCS Level II J code.
You may separately report an evaluation and management (E/M) service with the arthrocentesis, aspiration, or injection codes, provided the service is significant and separately identifiable from the procedure. You must append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service to the appropriate E/M service code.
For example, an established patient presents to the office for evaluation of left knee pain and other complaints, such as systemic sclerosis. The provider performs a detailed history and exam with medical decision-making of moderate complexity. The provider performs an aspiration of the left knee and orders a complete transthoracic echo for the systemic sclerosis. This should be reported:
99214-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity.
If the patient reports to the office strictly for the aspiration, arthrocentesis, or injection procedure, you typically will not report a separate E/M service.
Laterality Matters
When reporting codes for joint arthrocentesis, aspiration, or injection procedures, modifier LT Left side or modifier RT Right side may be appropriate. For example, a patient presents to the office for an injection of 40 mg of triamcinolone to the left hip for trochanteric bursitis of the left hip. This should be reported:
20610-LT
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg x 4
M70.62 Trochanteric bursitis, left hip
Dawson Ballard, Jr., CPC, CPC-P, CEMC, CPMA, CRHC, CCS-P, is an AAPC Fellow and a coder for Mid-America Rheumatology Consultants. Ballard is a member of the Overland Park, Kan., local chapter.
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Is the following scenario correct then?.
For example, the doctor performs aspiration on 3 ganglion cysts. So that would be coded as:
20612
20612-59
20612-29
I think that the descriptor for 20612 should be updated by CPT to say “each” instead of cyst(s). I have always thought that if grammar for singular and plural i.e. “cyst(s)” would mean to report 1 unit of the code for one OR more. So that, if the doctor only aspirated/injected 1 ganglion cyst it would be 20612 X1 and if more cysts were done, it would be 20612 X1, but the parenthetical instructional note says for multiple cysts add modifier -59 which indicates that each cyst would be coded with all after the first get a -59.
My doctor wants to bill 20600-LT and J3301 for a Ganglion on the left wrist aspirate. I want to bill 20612 -LT with no J code M67.432. He cant bill for the J code because is inclusive to the procedure 20612, am I correct?