Coding imaging guidance with small joint injection
Imaging guidance may be employed to ensure accurate needle placement, during either aspiration or injection.
In 2015, the AMA revised previous joint (or bursa) aspiration/injection codes to specify ?without ultrasonic guidance,? while adding codes to describe the same procedures with ultrasonic (US) guidance.
? 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance.
? 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting.
? 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance.
? 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.
? 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa);without ultrasound guidance.
? 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 code application is straightforward, if the provider performs joint aspiration/injection with the aid of US guidance.
The choice of codes will be 20604, 20606, or 20611 depending on the joint targeted.
Per CPT(R) instructions, you may separately report fluoroscopic, CT, or MRI imaging guidance for needle placement during joint/bursa aspiration/injection.
? 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
? 77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
? 77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
In such a case, you would report the ?without ultrasonic guidance? code for the aspiration/injection, as well as 77002, 77012, or 70021, as appropriate.