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?
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.
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.
Ganglion of foot ICD-10-CM M67.479 is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 557 Tendonitis, myositis and bursitis with mcc 558 Tendonitis, myositis and bursitis without mcc
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.
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.
Fluid aspiration is a medical procedure where doctors use a needle to drain the fluid from a ganglion cyst. This type of cyst often forms in the joints of your wrist or hand. Ganglion cysts are usually benign and not harmful. They can put pressure on the nerves, cause pain and limit movement in the affected joint.
A ganglion cyst diagnosis may be confirmed by aspiration, a process in which your doctor uses a needle and syringe to draw out (aspirate) the fluid in the cyst. Fluid from a ganglion cyst will be thick and clear or translucent.
Code Description: 20612 (Aspiration and/or injection of ganglion cyst(s) any location).
The CPT codes for arthrocentesis aspiration or injection procedures are 20600-20611.
The cause of ganglion cysts is not known. One theory suggests that trauma causes the tissue of the joint to break down, forming small cysts that then join into a larger, more obvious mass. The most likely theory involves a flaw in the joint capsule or tendon sheath that allows the joint tissue to bulge out.
To aspirate the cyst, the radiologist attaches a syringe to the needle and draws fluid into the syringe until no more fluid can be obtained. Cyst aspiration can be done by ultrasound (Fig. 6-11) or, less commonly, by x-ray guidance using a fenestrated compression plate and mammography.
It grows out of a joint or the lining of a tendon, looking like a tiny water balloon on a stalk, and seems to occur when the tissue that surrounds a joint or a tendon bulges out of place. Inside the cyst is a thick lubricating fluid similar to that found in joints or around tendons.
Aspiration and steroid injection reduces the volume of the cyst. The effect wanes off progressively over a period of time. Majority will have a smaller cyst at sixth month at the same site. It may work better in the smaller cysts.
A large-bore needle is placed within the ganglion to remove the thick, viscous fluid. Simple aspiration is associated with high rates of recurrence (>50%). Injection of corticosteroid after aspiration can help to shrink or resolve the lesions and reduces recurrences to between 13% and 50%.
Ganglion cysts arise from myxoid degeneration of the connective tissue of the joint capsule, are filled with viscoid fluid or gelatinous material, and have a fibrous lining. Synovial cysts also contain gelatinous fluid and are lined with cuboidal to somewhat flattened cells consistent with a synovial origin.
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.