Looking for billing and reimbursement tips for CPT code 20610? We can help you with that! CPT code 20610 may seem like any other code, but it is quite popular in rheumatology and orthopedics. The primary reason? It represents a widely used procedure for treating joint pain, including bursitis.
Did you know that over 30,000 Americans experience bursitis every year? In fact, this condition is pretty common in athletes, affecting 10% of the runners. That’s why many primary care physicians, orthopedic surgeons, and rheumatologists encounter and treat such patients regularly. However, many of them find the reimbursement process quite challenging.
Are you also struggling with this code? Read our guide to learn what it’s all about!
CPT Code 20610 – Description
So, what exactly does this code cover? CPT code 20610 is widely used in rheumatology and orthopedics billing. In simple terms, it refers to a medical procedure in which a healthcare provider treats joint pain by inserting a needle into a major joint or bursa (a fluid-filled sac cushioning spaces between bones, muscles, and other tissues). The doctor uses a syringe to:
- Remove fluid from a major joint or bursa (aspiration) and, or
- Inject a therapeutic substance to relieve pain
This procedure helps reduce pain and swelling and allows healthcare providers to diagnose joint issues. In short, rheumatologists, primary care physicians, and orthopedic specialists use CPT code 20610 to treat conditions such as bursitis or osteoarthritis without ultrasound guidance.
Keep one thing in mind when using this code. You can only apply CPT code 20610 when performing aspiration or delivering medication directly into major joints like the hip, shoulder, knee, or subacromial bursa.
Scenarios Where CPT Code 20610 is Applicable
Here are some specific examples of using CPT code 20610:
Shoulder Joint Aspiration
Let’s start with a simple scenario! Suppose a 15-year-old cyclist falls and lands on his right arm while taking a sharp turn. He notices swelling and stiffness in his shoulder and tries to reduce it by applying ice. However, as the swelling and pain increase, he eventually visits urgent care. The doctor evaluates the patient and suspects fluid buildup.
To relieve the symptoms, the doctor performs a joint aspiration. During the procedure, he uses a syringe to remove fluid from the inflamed bursa and injects a corticosteroid to reduce inflammation and pain. The provider then bills this procedure using CPT code 20610.
Treating Trochanteric Bursitis
Still unsure about this code? Here is another example! Assume a warehouse employee develops trochanteric bursitis (painful swelling near the hip joint) due to consistently lifting heavy boxes. He experiences constant hip pain and finds it difficult to walk upstairs.
After trying several home remedies, he finally visits a rheumatology clinic for an evaluation. The doctor conducts a thorough examination, reviews the events leading to the condition, and diagnoses trochanteric bursitis.
To ease the patient’s pain, the rheumatologist aspirates fluid from the swollen area near the hip joint and injects an anti-inflammatory medicine, a corticosteroid. The billing team then reports this procedure using CPT code 20610.
Treating Knee Pain Due to Osteoarthritis
Suppose a 46-year-old woman with primary osteoarthritis — a common type of arthritis — suffers from severe pain in her left knee. Due to this, she finds it difficult to perform daily tasks. After trying various oral medications with no relief, the doctor recommends a joint injection for targeted pain management.
During the procedure, the healthcare provider directly injects a corticosteroid into her left knee to reduce pain and swelling. The billing team then uses CPT code 20610 with the LT modifier to report that this procedure was performed on the patient’s left knee.
Applicable Modifiers for CPT Code 20610
Are you facing claim denials for treating bursitis? We recommend using modifiers with CPT code 20610 when necessary. Payers require specific information about where you aspirated a bursa or injected medicine. You can communicate these details, along with other relevant information, through the following modifiers:
Modifier RT
You can use the RT modifier with CPT code 20610 if you performed the procedure (aspiration and/or injection) on the right major joint.
Modifier LT
If the procedure was performed on the left knee, hip, or shoulder joint, use modifier LT with CPT code 20610.
Modifier 50
Modifier 50 indicates a bilateral procedure. Hence, you can append it to CPT code 20610 if you performed a joint aspiration and/or injection on both sides of the body. In this case, both knees, shoulders, or hip joints.
What is the difference between CPT 20610 & 20611?
The key difference between CPT codes 20610 and 20611 is the use of ultrasound guidance. To be more specific, healthcare providers use CPT code 20610 to report joint injections without ultrasound guidance. On the other hand, billing specialists use CPT code 20611 when doctors use ultrasound imaging to examine and extract fluid buildup in major joints.
Other than that, both codes are almost the same, covering aspiration and/or injection into major joints or bursae to relieve pain and inflammation.
CPT Code 20610 – Billing & Reimbursement Guidelines
To properly use CPT code 20610, simply follow these steps:
Verify Medical Necessity
The most important step when using CPT code 20610 is to ensure the procedure is medically necessary. Otherwise, you can face claim denials. Therefore, verify medical necessity in advance and make sure that this procedure is supported by an appropriate diagnostic (ICD-10) code.
Apply 20610 to the Correct Procedure
The next important thing to remember? Use this code only if healthcare providers perform joint aspiration and/or injection procedures without ultrasound guidance. Also, remember to report only one unit of CPT code 20610 per joint treated.
In simple words, regardless of how many aspirations or injections are performed on one joint within the same session, you can bill only one unit of this code.
Use the Appropriate Modifiers to Specify the Location
The Centers for Medicare and Medicaid Services (CMS) requires you to use anatomic modifiers, such as LT and RT, to specify the treatment location. However, if you performed the procedure on both sides, you can use modifier 50 with CPT code 20610.
Bill the Medication Separately
Keep in mind that Medicare does not cover the drug supply (other than local anesthetic) for intra-articular injections. Therefore, report the injected medicine separately with an appropriate HCPCS level II code.
Maintain Complete Documentation
As usual, clear and thorough documentation is essential for billing a procedure. Therefore, record every detail about the procedure, including:
- The joint treated (hip, knee, or shoulder)
- The reason for intra-articular injection
- The reason for aspiration
Your documents should also support the medical necessity of the procedure. You can do that by noting:
- Pre-procedure patient symptoms, such as swelling, tenderness, and motion limitations
- Repetitive habits that led to their condition.
Also, specify the medication used and the amount injected.
Check Payer-Specific Requirements
Our final advice? Verify payer-specific requirements before billing, especially frequency limitations on injections. This step will help you avoid claim denials and payment issues.
Conclusion
The billing process for any procedure, including intra-articular injections, is challenging. However, you can simplify many steps if you understand the appropriate codes. CPT code 20610 is widely used both in rheumatology and orthopedics. It covers joint pain treatment via aspiration and/or injections. The most important thing to remember? This code covers this procedure only if healthcare providers perform it without ultrasound guidance. We have discussed this code in detail so you can use it correctly. But if you are tired of dealing with claim denials and rejection, you can choose our orthopedic billing services to get back on track.
