Knee Joint Injections: Watch for Ultrasound Guidance Denials

Although there is evidence ultrasound guidance improves the accuracy of knee joint injections and reduces procedural pain in some cases, there is insufficient evidence ultrasound guidance improves clinical outcomes. Consequently, Highmark Medicare Services (HMS) does not support coverage of ultrasound guidance for all knee joint injections.
HMS, Medicare Administrative Contractor (MAC) for jurisdiction 12, recently performed audits for procedure code 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation and found providers were using ultrasound guidance for knee joint injections without providing documentation to support its medical necessity.
“Unless there is documentation provided to support the medical necessity for the ultrasound guidance for knee joint injections, the ultrasound guidance may be denied, ” HMS writes in a May 18 provider bulletin.
The use of ultrasound guidance for knee joint injections may be considered medically reasonable and necessary by HMS if documentation supports one of the following:

• The failure of the initial attempt at the knee joint injection where the provider is unable to aspirate any fluid.
• The size of the patient’s knee(s), due to morbid obesity or disease process, inhibits the provider’s ability to inject the knee(s) without ultrasound guidance.
• The provider is planning to drain a popliteal (Baker’s) cyst.

Package inserts for knee joint injections drugs do not indicate the necessity of using ultrasound guidance for safe and effective use, according to the HMS provider bulletin.

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