Orthopedic Coding Alert

Question: We performed an arthrocentesis (20610) using pre-procedure and intra-procedure x-rays for needle guidance/placement. No contrast was used. Can we bill these x-rays with the hip injection procedure? 

Alaska Subscriber

Answer: It depends. When the physician injects a small amount of contrast into the hip under fluoroscopic guidance (to ensure proper needle location before administering an anesthetic or steroid injection), you should submit code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) to report the fluoroscopic imaging performed. 

As stated in the descriptor nomenclature, you may code 77002 to describe fluoroscopic guidance for all types of needle placement, such as for biopsy, aspiration, injection, or placement of a localization device. You would also report the injection of a steroid or an anesthetic agent into the hip using the joint injection code 20610, (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

You should not confuse hip injection of an anesthetic or steroid under fluoroscopic guidance with hip arthrography. When a physician performs a conventional (radiographic) hip arthrogram, you should report an arthrography injection code (27093, Injection procedure for hip arthrography; without anesthesia, or 27095, Injection procedure for hip arthrography; with anesthesia) and the arthrography imaging code 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation). In this instance, you should not report 77002 in addition to code 73525 because current imaging practice dictates that fluoroscopy (77002) is considered a component of organ/anatomic-specific radiological supervision and interpretation procedures (i.e., 73525). 

The key is not the actual volume of contrast injected but the intention. If the contrast is injected only to confirm needle position within the joint, the quantity does not matter. If instead the contrast is injected with the intention to outline the joint surface to perform a radiographic arthrogram, then it is an arthrogram — even if only a few cc’s of contrast material are injected. Again, it is not the volume of contrast but the intention that defines the service.