Wiki CPT code 20611

[Sonia0516]

Can anyone please help.....
An orthopedic practice is questioning if they can use CPT code 20611(w/ ultrasound guidance) for all (hip, knee ,shoulder ,etc.) aspirations/injections? Is there anywhere I can find guidelines for this code that are relevant to all insurance carriers?
Thank you in advance!

 

[dustie]

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

If the provider performs joint aspiration/injection with the aid of US guidance, code application is straightforward: Select 20604, 20606, or 20611, depending on the joint targeted.

Example: Using US guidance for precise needle placement, the provider injects bupivacaine into the knee joint for pain management. Because the knee is defined as a major joint, the correct code is 20611. You would not separately report the US guidance (e.g., 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) because it’s an inclusive component of the primary procedure.

So far in California all of our payers are recognizing and reimbursing this CPT Code.
I would verify all payers have a fee schedule for this code.

 

[hopepg]

Check necessity conditions with your various payers, there may or may not be coverage restrictions. Easiest way is to just go to their website & do a search of their policies.
Medicare Jurisdiction H currently has this code (20611) on their "Medical Review" list. Meaning they won't pay on it until they receive the medical record/documentation.

 

[amedrano73]

20611 with prp injections

Can a physician bill for the aspiration (20611) with a PRP injection? One of our Ortho providers marked the fee ticket for 20611 and prp injection 0232T, I'm not sure this is correct. Help?