Neurology & Pain Management Coding Alert

Question: Notes indicate that the provider performed arthrocentesis injections on a pair of joints; he used ultrasound (US) guidance on one injection and no guidance on the other. What is the most appropriate CPT^® coding combination for this encounter?

Kentucky Subscriber

Answer: Given this information, the best that we can do is explain the code choices you have for this encounter; from there, you’ll have to pick the most appropriate codes.

Why? In addition to specifying whether the provider used fluoroscopy, arthrocentesis injections (or aspirations) require you to drill down into anatomy to get the right code. You should gently remind your provider that more information in the notes would really help the practice’s bottom line. Going back to get more specifics after a claim is submitted for coding decreases efficiency. Also, if the coder chooses incorrectly based on lackluster provider notes, that could lead to downcoding (bad) or upcoding (worse).

Here’s a breakdown of the codes you’ll use depending on the anatomy of the arthrocentesis injections.

Small joint or bursa: If the notes indicate that the provider injected a small joint or bursa, choose either 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance) or 20604 (… with ultrasound guidance, with permanent recording and reporting). As the descriptors indicate, small joints/bursa include (but are not limited to) fingers and toes.

Intermediate joint or bursa: If the notes indicate that the provider injected an intermediate joint or bursa, choose either 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance) or 20606 (… with ultrasound guidance, with permanent recording and reporting.) As the descriptors indicate, intermediate joints/bursa include (but are not limited to) wrists, elbows, and ankles.

Major joint or bursa: If the notes indicate that the provider injected a major joint or bursa, choose either 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance) or 20611 (… with ultrasound guidance, with permanent recording and reporting). As the descriptors indicate, major joints/ bursa include (but are not limited to) shoulders, hips, and knees.

If you’re reporting the same code for the left and right side of the patient’s body, append modifier 50 (Bilateral procedure) to the code. For example, if notes indicate that the provider performed arthrocentesis aspirations on both of a patient’s knees with US, report 20611 with modifier 50 appended. Also, check with your payer to see if it requires modifiers LT (Left side) and RT (Right side) to indicate laterality on your claim. For example, if notes indicate that the provider performed an arthrocentesis injection on the patient’s left wrist without US, your payer might want you to report 20605 with modifier LT appended.