The joint effusion or the accumulation of intraarticular fluid can be caused by a variety of medical conditions, injuries, and infections. Arthrocentesis is the process of injecting joint fluid to establish a diagnosis, relieve discomfort, remove infected fluid, or inject the medication. Coding for arthrocentesis can be difficult. In the medical record, the physician should include a detailed description of the procedure. This will enable medical coding service providers to assign the appropriate codes to support the services rendered in order to receive proper reimbursement.
Arthrocentesis is the removal of synovial fluid from the joint space. It is also known as joint aspiration. The CPT code for arthrocentesis is critical. It is also done for drug therapy purposes to inject fluid into the joint space. This procedure code in interventional radiology coding is determined by the type of joint injected. It's used to rule out gout, arthritis, and synovial infections.
Arthrocentesis CPT Codes 20610, 20605, 20600 knee Injection
The CPT code for arthrocentesis is classified into three types of joints. The joints are classified as small, intermediate, or major. Fingers, toes, joints, and bursae are examples of small joints. The wrist, elbow, ankle, olecranon bursa, and temporomandibular joints are examples of intermediate joints. The major joints are the shoulder, hip, and knee joints, as well as the subacromial bursa. For each joint, we have a CPT code. The most common CPT codes for arthrocentesis without ultrasound guidance are 20600, 20605, and 20610.
Description of Arthrocentesis CPT Codes
There are four different imaging guidance used in arthrocentesis. The four imaging guidance are Fluoroscopic, ultrasound, MRI, and CT guidance. When we code a CPT code for arthrocentesis, we have to bill the imaging guidance. Hence, when we code the arthrocentesis we will code two CPT codes, one for the main procedure code for arthrocentesis followed by the imaging guidance used during the procedure. Below are a detailed description of arthrocentesis CPT codes.
Arthrocentesis CPT codes without Ultrasound (76942) Guidance
20600: Arthrocentesis, aspiration and /or injection, small joint or bursa (eg, fingers; toes); without ultrasound guidance, with permanent recording and reporting.
20605: Arthrocentesis, aspiration and /or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, writs, elbow or ankle, olecranon bursa;); without ultrasound guidance, with permanent recording and reporting.
20610: Arthrocentesis, aspiration and /or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance, with permanent recording and reporting.
Procedure codes with ultrasound guidance
20604: Arthrocentesis, aspiration and /or injection, small joint or bursa (eg, fingers; toes); with ultrasound guidance, with permanent recording and reporting.
20606: Arthrocentesis, aspiration and /or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, writs, elbow or ankle, olecranon bursa;); with ultrasound guidance, with permanent recording and reporting.
20611: Arthrocentesis, aspiration and /or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting
We can use the 50 along with procedure CPT codes 20600, 20604, 20605, 20606, 20610, and 20611 to code bilateral joint aspiration on both sides. However, when performing joint aspiration on two different small or major joints, we must use a 59 modifier with any of the CPT. For example, if arthrocentesis is performed on the shoulder and hip joint, the 20610 and 20610-59 modifiers can be coded. As a result, by providing 59 modifiers, we distinguish the first procedure CPT from another.
Arthrocentesis Procedure code Coverage Indications and Medical Necessity
Several hyaluronic acid polymers have been approved and marketed as implanted prosthetic devices. In clinical studies, sodium hyaluronate and Hylan G-F-20 injections into the joint space of osteoarthritic knees have been shown to be marginally more effective than placebo procedures in reducing pain and improving functional capacity in some patients. These marginally beneficial results are more prominent with the higher molecular weight compound Hylan G-F20. There is no evidence that these agents reverse or slow the osteoarthritic process in the injected joints. The long-term consequences of multiple injections are unknown.
Arthrocentesis CPT code Coverage Indications
Medicare will cover the cost of the injection and the injected hyaluronate polymer for patients who meet the following clinical criteria:
- Knee pain is associated with radiographic evidence of osteophytes in the knee joint, sclerosis in the bone adjacent to the knee, or joint space narrowing.
- Morning stiffness of fewer than 30 minutes in duration or crepitus on motion of the knee.
- The pain cannot be attributed to other forms of joint disease.
- The prosthetic device is approved by the Food and Drug Administration (FDA) for intra-articular injection.
- Pain that interferes with functional activities (e.g., ambulation, prolonged standing, ability to sleep).
- Lack of functional improvement following a trial of at least three months of conservative therapy, or the patient is unable to tolerate Non-Steroidal Anti-Inflammatory Drug (NSAID) therapy because of adverse side effects.
- Bilateral injections may be allowed if both knees meet the criteria.
The appropriate records documenting the improvement must be maintained in the medical record and made available to Medicare upon request.
Arthrocentesis CPT code Bill Type Codes:
Contractors may specify Bill Types to assist providers in identifying Bill Types that are commonly used to report this service. The absence of a Bill Type does not preclude the policy from applying to that Bill Type. The absence of all Bill Types indicates that Bill Type has no bearing on coverage, and the policy should be assumed to apply equally to all claims.
013x Hospital Outpatient
018x Hospital – Swing Beds
021x Skilled Nursing – Inpatient (Including Medicare Part A)
071x Clinic – Rural Health
073x Clinic – Freestanding
074x Clinic – Outpatient Rehabilitation Facility (ORF)
077x Clinic – Federally Qualified Health Center (FQHC)
083x Ambulatory Surgery Center
085x Critical Access Hospital
Contractors may specify Revenue Codes to assist providers in identifying Revenue Codes that are commonly used to report this service. Most Revenue Codes are simply advisory in nature. Services reported under other Revenue Codes are also subject to this coverage determination unless otherwise specified in the policy. The absence of all Revenue Codes indicates that Revenue Codes have no bearing on coverage, and the policy should be assumed to apply equally to all Revenue Codes.
025X Pharmacy – General Classification
036X Operating Room Services – General Classification
049X Ambulatory Surgical Care – General Classification
051X Clinic – General Classification
0636 Pharmacy – Drugs Requiring Detailed Coding
076X Specialty Services – General Classification
Reporting the services provided using all of the appropriate code sets and modifiers is essential for accurate reimbursement. So make sure that claims are submitted with the correct CPT codes and diagnosis codes to support the medical necessity of the procedures performed and ordered.
Hopefully, you now have a better understanding of the CPT code for arthrocentesis. Continue reading the page to learn more about billing and coding.