CPT® also provides codes for aspiration and/or injection into a ganglion cyst or for treatment of a bone cyst. For a ganglion cyst treatment, report 20612 Aspiration and/or injection of ganglion cyst (s) any location, regardless of the location. For multiple ganglion cysts, report 20612 and append modifier 59 Distinct procedural service.
29848 What are the procedure and diagnosis codes used to describe the arthrocentesis of ganglion cyst of toe joint, both injection and aspiration? 20612, M67.479 What is the procedure code used to describe the excision of maxillary torus palatinus?
** Use code 20610 for an Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa). Use this code if an SI Joint Injection is done without any imaging (instead of 27096 or G0260). Correspondence Language Policy/Example Number 10.20000 - Standards of medical/surgical practice
Ganglion cyst of the right dorsal wrist Ganglion cyst of the right volar wrist ICD-10-CM M67.431 is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 557 Tendonitis, myositis and bursitis with mcc
CPT® Categorizes Codes Arthrocentesis, aspiration, or injection is the process of inserting a needle into a joint or bursa to inject medication, or aspirate fluid for diagnosis or pressure relief. CPT® codes for these procedures are 20600-20615.
20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.
The correct CPT code for the aspiration of a ganglion cyst is 20612. The aspiration technique is identical to the fine needle aspiration for biopsy. If you are aspirating the cyst, you are already removing fluid that can be sent for analysis.
Effective for claims with dates of service on or after Jan. 1, 2015, you may no longer report image guidance separately with 20600, 20605, or 20610. Instead, you would report 20604, 20606, or 20611, as appropriate.
Joint aspiration is a procedure to remove excess fluid through a needle from a joint (commonly a knee, ankle, elbow or hip). Joint injection involves injecting medications, such as corticosteroids, into the joint to relieve pain. Appointments 216.444.2606.
The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting).
Code Description: 20612 (Aspiration and/or injection of ganglion cyst(s) any location).
Use 20610 for a major joint or bursa, such as the shoulder, knee, or hip joint, or the subacromial bursa when no ultrasound guidance is used for needle placement. Report 20611 when ultrasonic guidance is used and a permanent recording is made with a report of the procedure.
Report arthrocentesis on:Small joints or bursa — for example, fingers or toes — using:20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance.20604 with ultrasound guidance, with permanent recording and reporting.More items...•
Place the CPT code 20610 in item 24D. If the drug was administered bilaterally, a -50 modifier should be used with 20610.
Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size (e.g., two large joints, left knee and left shoulder).
The biller billed the CPT code 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst ) without the modifier-50.
CPT® codes for these procedures are 20600-20615 .#N#CPT® categorizes the codes based on the type of joint or bursa, and whether ultrasound guidance is performed. Report arthrocentesis, aspiration, or injection on:#N#Small joints or bursa — such as the fingers or toes — using 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance, or 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting.#N#Intermediate joints or bursa — such as temporomandibular, acromioclavicular, wrist, elbow, ankle or olecranon bursa — using 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance, or 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.#N#Major joints or bursa — such as the shoulder, hip, knee, or subacromial bursa — using 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance, or 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.#N#Per CPT® guidance, do not report 20600, 20604, 20605, and 20606 with 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation. Also, do not report 20610 and 20611 with 27370 Injection of contrast for knee arthrography or 76942. If fluoroscopic, computed tomography (CT), or magnetic resonance imaging (MRI) guidance is performed, also report the appropriate radiology code, such as:#N#+77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)#N#77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation#N#77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
For example, 20610 specifies “arthrocentesis, aspiration, and/or injection of a major joint or bursa.” Per CPT® guidance, if an aspiration is performed on a major joint/bursa, and an injection is performed immediately following the aspiration on the same major joint/bursa, report 20610 one time. If the procedure is performed on multiple joints, report separate codes for each joint. If medication is injected, report the appropriate HCPCS Level II J code.#N#You may separately report an evaluation and management (E/M) service with the arthrocentesis, aspiration, or injection codes, provided the service is significant and separately identifiable from the procedure. You must append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service to the appropriate E/M service code.#N#For example, an established patient presents to the office for evaluation of left knee pain and other complaints, such as systemic sclerosis. The provider performs a detailed history and exam with medical decision-making of moderate complexity. The provider performs an aspiration of the left knee and orders a complete transthoracic echo for the systemic sclerosis. This should be reported:#N#99214-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity.#N#If the patient reports to the office strictly for the aspiration, arthrocentesis, or injection procedure, you typically will not report a separate E/M service.
You may separately report an evaluation and management (E/M) service with the arthrocentesis, aspiration, or injection codes, provided the service is significant and separately identifiable from the procedure.
Insurers will often deny a claim reporting an arthrocentesis code , such as 20610, and an evaluation and management (E/M) service for the same encounter. The Medicare Physician Fee Schedule (MPFS) Relative Value File assigns 20610 a zero-day global period. This means the procedure is valued to include an initial assessment and other pre-service work; therefore, you would not report an E/M service for a planned injection when the patient presents without complications or a new problem.
Report only a single unit of the applicable arthrocentesis code, such as 20610, for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. For example, if the physician administers two injections, one on either side of the left knee, you will report 20610 x 1. Likewise, if aspiration is performed on a major joint/bursa, and an injection is performed immediately following the aspiration on the same major joint/bursa, report 20610 one time per CPT® guidance.
When a joint causes pain, swells, is red, or has a limited range of motion, a doctor may recommend using a needle and syringe to remove synovial fluid from the joint. This procedure is called arthrocentesis, commonly known as joint aspiration. Usually performed in a doctor’s office, arthrocentesis is often used both as a diagnostic ...
Note the requirement of permanent recording and reporting for the ultrasound guidance; if there is no permanent recording and reporting, you must report the code for the service without ultrasound guidance (20600, 20605, or 20610) .
When reporting codes for unilateral joint arthrocentesis, the use of modifier RT or LT on the injection procedure (e.g., CPT® 20610) may be appropriate to indicate which knee was injected. For example, a patient presents to the office for an injection of 40 mg of triamcinolone to the right hip for trochanteric bursitis of the right hip. The following codes should be reported:
For Medicare payers, the aspiration/injection codes do not include the drug supply (other than local anesthetic) for the injection. When medication is injected, report the appropriate HCPCS Level II J code separately if the provider paid for the drug.
Stacy Chaplain, MD, CPC, is a development editor at AAPC. She has worked in medicine for more than 20 years, with an emphasis on education, writing, and editing since 2015. Prior to AAPC, she led a compliance team as director of clinical coding quality for a multispecialty group practice. Chaplain received her Bachelor of Arts in biology from the University of Texas at Austin and her Medical Doctorate from the University of Texas Medical Branch in Galveston. She is a member of the Beaverton, Oregon, local chapter.
Use code 20610 for an Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa). Use this code if an SI Joint Injection is done without any imaging (instead of 27096 or G0260)
20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting (Do not report 20610, 20611 in conjunction with 27370, 76942) (If fluoroscopic, CT, or MRI guidance is performed, see 77002, 77012, 77021)
For example, when a small joint or bursa arthrocentesis, aspiration and/or injection (CPT code 20600) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 20600 when the same physician performs both procedures.
This section states that no payment shall be made to any provider for any claims that lack the necessary information to process the claim.
For example, CPT code 25115 describes a radical excision of a bursa or synovia of the wrist. It is standard surgical practice to preserve neurologic function by isolating and freeing nerves as necessary. A neuroplasty (e.g. CPT code 64719) should not be reported separately for this process. Therefore, CPT code 64719 is bundled into CPT code 25115.
As of January 1, 2015, there is a coding change to the arthrocentesis injection codes (20600 – 20611). The codes are now separated to reflect an injection/aspiration with or without ultrasound guidance. The coding corner below will demonstrate an example of this change.
Arthrocentesis, aspiration and/or injection (20600, 20605, 20610) is a covered service under the Medicare program when performed by a physician/ non-physician practitioner ( NPP) in compliance with state laws, within their scope of practice/training and within the accepted standards of medical practice.
CPT® 20610 describes aspiration (removal of fluid) from, or injection into, a major joint (defined as a shoulder, hip, knee, or subacromial bursa), or both aspiration and injection of the same joint. The procedure may be performed for diagnostic analysis and/or to relieve pain and swelling in the joint.
Based on feedback from Healthcare Business Monthly readers, and what we hear on AAPC Member Forums, one such “problem code” is 20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.
For Medicare payers, 20610 does not include the drug supply (other than local anesthetic) for injection. If the provider paid for the drug, he or she may report the supply separately using the appropriate HCPCS Level II supply code.
John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.