Looking to report an intermediate joint aspiration or injection without ultrasound guidance? You can use CPT code 20605! Let’s be real; coding for joint aspiration or injections is quite complicated. With so many options, you cannot just pick a code and hope for the best.
For timely payments, you must understand the key difference between these codes. CPT code 20605 is commonly used in orthopedics, rheumatology, and pain management billing. But how is it different from other joint aspiration/injection codes? Read on to learn the difference, including its correct application.
CPT Code 20605 – Description
CPT code 20605 covers arthrocentesis, commonly known as joint aspiration or injection, in the intermediate joint or bursa. To be more specific, it refers to a common orthopedic or pain management medical procedure. So, what do healthcare providers actually bill for when they use this code?
Healthcare providers use CPT code 20605 when they insert a needle into a patient’s intermediate joint or bursa (fluid-filled sac) for:
- Removing fluid and, or
- Injecting a therapeutic drug for pain relief
This process of removing fluid from an intermediate joint, such as the wrist, elbow, ankle, or olecranon bursa, is called aspiration. Keep one thing in mind while using this code. CPT code 20605 covers intermediate joint aspiration without ultrasound guidance.
Simply put, you can only apply this code if you did not use real-time imaging during aspiration to visualize the intermediate joint.
Scenarios Where CPT Code 20605 is Applicable
Here are three applicable scenarios for CPT code 20605:
Managing Olecranon Bursitis
Did you know that olecranon (elbow) bursitis is a relatively common condition, especially among athletes? There is evidence for that! According to a study, 126 NBA athletes sustained 192 combined elbow and shoulder injuries from 2015 to 2020. So, for our first scenario, let’s envision something similar.
Suppose a 32-year-old basketball player with a history of injuries falls on his elbow while taking a charge. He arrives at an urgent care clinic with noticeable swelling. The athlete further complains of pain and a locked elbow.
After taking his history and noticing the symptoms, the physician recommends joint aspiration, suspecting effusion. The healthcare provider inserts a thin needle into the patient’s olecranon bursa to drain the fluid. He then sends the collected sample to the lab for further analysis and reports this aspiration without ultrasound guidance with CPT code 20605.
Ankle Joint Aspiration
Ankle sprains are one of the most common workplace injuries, affecting 25,000 workers every day. But did you know that severe sprains can lead to joint effusion (abnormal accumulation of fluid)?
Therefore, for our second scenario, assume a 28-year-old construction worker sprains his ankle after stepping off a ladder in a hurry. His ankle swells within the first 24 hours and becomes tender to the touch. After trying several conservative treatments, including anti-inflammatory medicine, without any relief, he finally visits a primary care clinic.
The physician conducts a physical examination of the patient’s ankle and notices joint effusion. He then performs an ankle joint aspiration without ultrasound guidance and injects a therapeutic drug to reduce pain. The healthcare provider then uses CPT code 20605 to file a claim for this service.
Wrist Joint Aspiration
Bursitis often occurs due to repetitive motions. That’s why painters, gardeners, and carpenters frequently suffer from wrist bursitis (inflammation of the wrist joint bursae). For the final scenario, let’s suppose a 29-year-old abstract artist needs to complete several paintings before an exhibition.
After working long hours at awkward angles with repetitive brush strokes, she experiences a swollen, sore, and stiff right wrist by the end of the first week. She tries icing and anti-inflammatory medications, but her condition persists. Finally, she visits a nearby clinic to manage her condition.
After a thorough physical examination, the healthcare practitioner suspects wrist bursitis due to overuse and pressure. He then performs a wrist joint aspiration without real-time imaging to remove fluid. His billing team uses CPT code 20605 to bill for the procedure.
Applicable Modifiers for CPT Code 20605
The following modifiers are usually used with CPT code 20605:
Modifier 50
Did you perform an intermediate joint aspiration on both sides of the body within the same session? For example, if you removed fluid from both of a patient’s wrists, ankles, or elbows without real-time visualization, use modifier 50 with CPT code 20605.
Modifier LT
Laterality modifiers can help you specify the side on which you performed intermediate joint aspiration/injection. Append modifier LT to code 20605 if you performed the procedure on the left side of the body (left wrist, elbow, or ankle).
Modifier RT
On the other hand, apply modifier RT to CPT code 20605 if you inserted a needle into the right side of the patient’s body to remove fluid and then subsequently administered a therapeutic drug to provide relief.
CPT Code 20605 – Billing & Reimbursement Guidelines
Are you risking denials due to unclear requirements for code 20605? Ditch your old practices and follow our tips for timely approvals:
Use CPT Code 20605 Correctly
If you missed it earlier, let us restate that CPT code 20605 specifies intermediate joint aspiration and or injection. This involves directly inserting a needle into an ankle, wrist, or elbow joint or olecranon bursa to drain excessive fluid and then inserting a therapeutic drug (optional).
Now, here is the trickier part! Healthcare providers often confuse this code with CPT code 20600 or 20610. The reason? Similar descriptions. Also, keep one more thing in mind. You can only use 20605 if the joint aspiration is performed without ultrasound imaging.
Justify the Medical Necessity of Intermediate Joint Aspiration
Remember, you cannot bill an insurance payer for an unnecessary procedure. Therefore, make sure that there is a valid clinical reason for arthrocentesis before performing it. For justification, document the important details, including:
- Patient’s symptoms (swelling, pain, etc.)
- Physical examination findings (suspected joint effusion)
- Appropriate diagnosis (ICD-10) code (M70.21, M70.22, M25.471, M25.472)
- Prior conservative treatments (rest, icing, anti-inflammatory medication)
- The intermediate joint or bursa that was treated
- Type of procedure performed without ultrasound (only aspiration or aspiration and injection)
- Injected therapeutic medication
Append Laterality Modifiers
Both commercial and government payers require specificity. Therefore, append appropriate laterality modifiers to CPT code 20605 to specify where you have performed arthrocentesis.
Check Payer-Specific Requirements
Avoid compliance issues, including missing pre-authorization or modifiers. Keep in mind that insurance companies may have varying reimbursement policies for CPT code 20605. Therefore, take a proactive approach and confirm their requirements beforehand.
Summary
This is it! By now, coding for intermediate joint aspiration or injection should feel a lot simpler. Let us quickly summarize everything. CPT code 20605 specifies arthrocentesis (intermediate joint aspiration/injection) without ultrasound guidance. Healthcare providers perform this procedure to diagnose or treat joint problems, including inflammation and mobility issues. From description to billing tips, we have discussed everything about this code so you don’t confuse it with other similar codes. But mistakes can still happen. If you need some help to overcome denials and improve coding accuracy, choose a company with reliable orthopedic billing services.
