Hi - You may want to search the ortho forum to see if there is a similar question there. Many payers say not to use 51 because they will apply the rules, but also be sure to check for guidance like Medicare's NCCI policy manual, Chapter IV.I.17 (
https://www.cms.gov/files/document/chapter4cptcodes20000-29999final11.pdf): "17. Arthrocentesis procedures (e.g., CPT codes 20600- 20611) shall not be reported separately with an open or arthroscopic joint procedure when performed on the same joint. However, if an arthrocentesis procedure is performed on one joint and an open or arthroscopic procedure is performed on a different joint, the arthrocentesis procedure may be reported separately."