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
What is the CPT code 20604?
The Current Procedural Terminology (CPT ®) code 20604 as maintained by American Medical Association, is a medical procedural code under the range - General Introduction or Removal Procedures on the Musculoskeletal System. Subscribe to Codify and get the code details in a flash.
How do you report a bilateral procedure on CPT 20610?
If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), report one unit of 20610 with modifier 50 Bilateral procedure appended, per Centers for Medicare & Medicaid (CMS) instruction. Non-Medicare payers may specify different methods to indicate a bilateral procedure.
What are the CPT codes for diagnostic ultrasound?
Medical billing outsourcing to an experienced company helps providers determine and submit claims with the appropriate codes and modifiers as well as ensure reporting of services to meet the current requirements and policies of payers. Coding for diagnostic MSK ultrasound requires an understanding of CPT codes 76881, 76882 and 76942:
What is the CPT code for imaging guidance?
If fluoroscopic, CT, or MRI guidance is used report 20600, 20605, 20610 for the surgical procedure and see 77002, 77012, and 77021 to report imagining guidance separately. As always, my staff will be available to assist you with any questions are concerns you may have. 1.
What is procedure code 20604?
20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting.
What is the difference between 20610 and 20611?
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.
How do I bill a CPT 20600?
If the insurance requires one line to be billed for a bilateral service:Bill one line item and one unit with CPT code 20600 (arthrocentesis, aspiration and/or injection; small joint or bursa)Double your fee.Append modifier -50 as the primary modifier to indicate a bilateral service.More items...•
What J code goes with 20610?
You may report the injection using 20610 and the drug supply using J7323 Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose (once unit, per dose) linked to a diagnosis of M17.
Can 20611 be billed twice?
Coding Rationale 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). The code is billed twice because this was a bilateral procedure.
Does 20611 need a modifier?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
Does Medicare cover CPT code 20600?
* Medicare does not have a National Coverage Determination (NCD) for trigger point injections. * Local Coverage Determinations (LCDs) which address these injections exist and compliance with these LCDs is required where applicable.
Can you Bill 20600 twice?
Reporting Multiple Units 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.
What is intra articular administration?
An intra-articular injection is a type of shot that's placed directly into a joint to relieve pain. Corticosteroids (steroids), local anesthetics, hyaluronic acid, and Botox are the most common substances injected into joints for this treatment.
Does Medicare pay for hyaluronic acid knee injections?
Does Medicare Pay for Knee Gel Injections? Yes, Medicare will cover knee injections that approved by the FDA. This includes hyaluronan injections. Medicare does require that the doctor took x-rays to show osteoarthritis in the knee.
Do I need a modifier for 20610?
CPT code 20610 may always require a laterality modifier to represent the side of the body on which the service is executed as we know that all major joints in the human body are bilateral, i.e., Wrist, Knee, Hip. To represent the side of the body, there is always a need for a right or left modifier.
Can you bill an office visit with a joint injection?
Answer: Unfortunately, no. It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection.
What is 20611?
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)
What is the code for a hip arthrectomy?
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)
What is CPT code for bursa arthrocentesis?
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.
When did the coding change for arthrocentesis?
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.
Is it appropriate to bill an E/M visit?
It would not be appropriate to bill the E/M visit , because the focus of the visit is related to the knee pain, which precipitated the injection procedure. The evaluation of the knee problem and the patient’s medical suitability for the procedure is included in the injection procedure reimbursement
Is a surgical arthroscopy billable?
Procedure code guidelines are that if a surgical arthroscopy is performed on the same joint when a Joint Manipulation and/or Joint Injection are performed in the same case, only the scope procedure is billable.
Is arthrocentesis covered by Medicare?
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.
When was the self referral law enacted?
When enacted in 1989, Section 1877 of the Social Security Act (the Act) applied only to physician referrals for clinical laboratory services. In 1993 and 1994, Congress expanded the prohibition to additional DHS and applied certain aspects of the physician self-referral law to the Medicaid program. In 1997, Congress added a provision permitting ...
What is SRDP in healthcare?
The SRDP sets forth a process to enable providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute. Additionally, Section 6409 (b) of the ACA, gives the Secretary of HHS the authority to reduce the amount due and owing for violations of Section 1877.
When did the DHS issue advisory opinions?
In 1997, Congress added a provision permitting the Secretary to issue written advisory opinions concerning whether a referral relating to DHS (other than clinical laboratory services) is prohibited under section 1877 of the Act.
What is 20604 in ultrasound?
20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting (Do not report 20600, 20604 in conjunction with 76942) (If fluoroscopic, CT, or MRI guidance is performed, see 77002, 77012, 77021)
What is a 80300 drug screen?
80300 Drug screen, any number of drug classes from Drug Class List A, any number of non-TLC devices or procedures (eg, immunoassay) capable of being read by direct optical observation , including instrumented-assisted with performed (eg, dipsticks, cups, cards ,cartridges) per date of service
What is the CPT code for joint aspiration?
CPT has created a new set of codes for joint aspiration and/or injection which include ultrasound guidance (20604, 20606, 20611) . Additionally, existing codes (20600, 20605, and 20610) were revised to indicate when an Arthrocentesis, joint injection or aspiration is performed without ultrasound guidance.