Orthopedic Coding Alert

Coding varies depending on whether joint is small, intermediate, major.

Coding for joint injections seems like a breeze, right? Look for the joint your provider injected, line it up with the right CPT^® code and you’re done.

Not so fast: There are, in fact, far fewer joint injection codes than there are joints in the body. Also, they’re broken down as to whether or not guidance was used. So it gets a bit complicated sometimes.

During her HEALTHCON 2022 session, Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, CCS, AAPC Approved Instructor, ran attendees through some of the more pressing questions surrounding these needle procedures. Check out what she had to say.

Get Joint Size Right

The first set of joint injection codes Clements discussed were:

• 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance)
• 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance)
• 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance)

“These are your joint injections without ultrasound [US] guidance,” explained Clements. “Also, notice that these code descriptions cover the aspiration and/or injection of the joint in the code,” so you’ll report these codes once per joint.

It can be tricky finding out what constitutes small, intermediate, and major joints/bursas. “They do identify the different types of joint as examples within the code description, but naturally they do not list every joint or bursa,” said Clements. “In that case you’re going to have to kind of make some comparison on the size of the joint that your providers inject, and compare it to what is in the parentheses as examples.”

Look for US, Then Use These Codes

The codes discussed above were for a joint injection without US guidance; there are also codes for use when the provider uses US during a joint injection. Those codes are:

• 20604 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting)
• 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)
• 20611 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting)

Remember: As the descriptors indicate — and Clements stressed — your claim must satisfy the “permanent recording and reporting” portion in order to rightfully use the injection with US guidance codes.

If you’re lacking permanent recording and reporting in your joint injections, you should not report 20604, 20606, or 20611. In these cases, you’ll need to report 20600, 20605, or 20610.

Yes, You Could Code Separately for Fluoro/CT/MRI

As you can see, US guidance is indicated in the descriptors for 20604, 20606, and 20611. There are, however, other types of guidance that you might be able to report separately with these codes.

For these joint injection codes, “there is a parenthetical note that tells you that if your provider uses fluoroscopic, computed tomography [CT], or magnetic resonance imaging [MRI] during a joint injection, you should be able to code separately for the service,” Clements pointed out.

Per CPT^® 2022, under the descriptors for 20604/20606/20611, “If fluoroscopic, CT, or MRI guidance is performed, see +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 imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation].”