Arthrocentesis & Injection FAQ

Accurate coding is contingent upon two main factors: the type of joint or bursa involved and whether ultrasound guidance was utilized during the procedure. Refer to question 2 and 3 for additional details on this.

Yes, arthrocentesis or injections are classified based on the location of the joint or bursa as small, intermediate, or major. Both arthrocentesis and injection are included in the below CPT codes:

• 20600 – Small joint or bursa (fingers, toes), without ultrasound guidance
• 20605 – Intermediate joint or bursa (TMJ, acromioclavicular, wrist, elbow, able, olecranon bursa), without ultrasound guidance
• 20610 – Major joint or bursa (shoulder, hip, knee, subacromial bursa), without ultrasound guidance

As with all ultrasound codes, the CPT code descriptor requires permanent recording of the ultrasound image to report any “with ultrasound guidance” codes. If no permanent images are saved, the coder must assign the arthrocentesis code designates without ultrasound guidance (20600, 20605, or 20610). You cannot separately report ultrasonic guidance code 76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation with any of the “with ultrasound guidance” codes.

Examples of CPT codes that include ultrasound guidance:

• 20604 – Small joint or bursa (fingers, toes), with ultrasound guidance
• 20606 – Intermediate joint or bursa (TMJ, acromioclavicular, wrist, elbow, able, olecranon bursa), with ultrasound guidance
• 20611 – Major joint or bursa (shoulder, hip, knee, subacromial bursa), with ultrasound guidance

No. Only a single arthrocentesis code should be assigned per joint, irrespective of the number of aspirations and/or injections performed on that joint during the same session. Therefore, whether the ED physician performed both an aspiration and an injection or administered two injections at different sites of the same joint, the code for the arthrocentesis is only reported once.

Yes, if performed on two different joints. If the same procedure is performed on the same joint bilaterally, the 50 modifier or Rt and Lt is used to indicate bilateral procedures depending on the payer.

Reimbursement patterns vary by payer. Additionally, groups may opt not to code failed procedures for various reasons. If the group chooses to code and bill for failed procedures a modifier typically would be applied. For example, if the procedure is partially reduced or eliminated at the discretion of the physician or qualified health care professional, as defined by CPT, the procedure may be coded with a modifier 52 for “Reduced Services”. Another example is a procedure that is interrupted due to extenuating circumstances or threaten the well-being of the patient, as defined by CPT, the procedure may be coded with modifier 53 for “Discontinued Procedure”. Of note, both modifiers 52 and 53 typically result in reduced payment from payers.

Unfortunately, when a procedure is performed to facilitate performing another procedure such as for intra-articular anesthetic for reduction for a joint, these would not be separately billable.  However, if the joint is injected and then no reduction is performed, it would be billable as an arthrocentesis or injection.

Ex. Anterior shoulder dislocation reduced bedside after an intra-articular injection with 1% lidocaine with ultrasound guidance, no procedural sedation utilized

• CPT 20611 - Major joint or bursa (shoulder, hip, knee, subacromial bursa), with ultrasound guidance (billable for pain control but not if performed for reduction)
• CPT 23650 – Closed treatment of shoulder dislocation, with manipulation, without anesthesia

treatment of dislocation with/without fracture, with manipulation, without anesthesia reduction CPT code would be reported.