20610 CPT Code Explained

What is 20610 CPT CODE:

The American Medical Association maintains CPT code 20610 to cover the professional service of performing specific procedures for billing purposes. These procedures involve using a syringe or injection to perform arthrocentesis, aspiration, or injection of a major joint or bursa. To get proper service reimbursement, healthcare providers, medical coders, and billing professionals must understand the details and guidelines about reporting 20610. This article will provide information about the description of 20610, the procedures that 20610 covers, the performance of the procedure, billing criteria for 20610, documentation of 20610, which modifiers to use, examples of CPT 20610, and frequently asked questions about 20610.

Description:

“Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance, with permanent recording and reporting.”

What is Arthrocentesis?

A procedure involves using a syringe to collect synovial fluid from a joint or injecting medication into the joint capsule.

What is Aspiration?

The procedure of withdrawing fluid, tissue, or other substances from the body through a needle is called aspiration.

The Healthcare Provider Performs the Procedure Under CPT Code 20610 as Follows:

1. After getting the history, the healthcare provider assesses the symptoms and radiography findings and determines if the patient needs a joint aspiration or injection.
2. The healthcare provider explains the need for the procedure and the risks of the procedure to the patient.
3. After explaining all the benefits and risks of the procedure, the healthcare providers answer the questions and address the patient’s concerns.
4. The healthcare provider sterilizes the injection site and surrounding area to minimize the risk of infection. They may also administer local anesthesia after explaining to the patient to numb the area and overcome any possible discomfort during the procedure.
5. The healthcare professional performs arthrocentesis or administers an injection of medication or a combination of drugs with or without anesthesia into the joint or bursa using a sterile syringe.
6. The healthcare professional provides instructions on post-procedure care, such as rest, contraindications, activity restrictions, pain management, or follow-up appointments after the procedure.

What Procedures Does CPT 20610 Cover?

CPT code 20610 covers several procedures that involve the use of a syringe. Following are some of the procedures:

• CPT 20610 covers the joint aspiration procedure. It involves fluid removal from a joint. This procedure helps analyze the joint fluid for inflammation, infection, crystals, or other abnormalities for diagnostic purposes.
• It also bills the joint injections. These injections serve therapeutic purposes. The healthcare providers inject medications into the joints. These medications commonly include viscosupplements for joint conditions, corticosteroids for reducing inflammation, painkillers for pain relief, and hyaluronic acid for lubrication and pain relief in osteoarthritis.
• CPT 20610 covers the injections into the bursae. It is s small fluid-filled sac that provides cushioning between tendons, muscles, and bones. This bursa can sometimes undergo inflammation due to injury or other medical conditions. The injections help alleviate inflammation, reduce pain, and improve movement.

Billing Criteria for 20610:

1. It is a procedure code that bills for intraarticular injection. The physician’s bill must include the charge for the drug. The cost of the drug must represent an expense to the physician.

2. Bill only one unit for 20610 if the provider performs an injection procedure and an aspiration performed in the same session.

3. Only one procedure is allowed per joint when the healthcare provider administers additional substances concomitantly with viscosupplementation.

4. The healthcare provider must carefully use the appropriate modifiers mentioned above.

5. Claim denial will occur if the drug is not reasonable or denied.

How to Document CPT Code 20610 for Billing and Reimbursement Purposes?

While documenting 20610 for reimbursement, the healthcare provider must keep the following points under consideration:

• The healthcare provider must accurately document the joint or bursa that undergoes the procedure. They must also mention the type and amount of medication used, the method they follow, and any additional procedures or services they perform alongside the main procedure. Documenting all this information is crucial for proper coding and billing.
• The healthcare providers must understand the importance of reporting the modifiers with 20610 if required depending on the circumstances. These modifiers provide additional information or justify the use of CPT code 20610. Attaching the appropriate modifiers can lead to claim denials and affect reimbursement. It can affect the effective delivery of healthcare services.
• The healthcare providers must consider the reimbursement guidelines and requirements as different payers may have specific guidelines and requirements for reimbursement for CPT code 20610. The healthcare providers must update their knowledge, adhere to the payer’s policies, including any preauthorization requirements, and provide sufficient documentation to support the procedure’s medical necessity.

Modifiers used with 20610?

Following are some of the modifiers that the healthcare providers can append to CPT 20610:

Modifier 50:

Modifier 50 is appended to 20610 when the healthcare provider performs bilateral joint aspiration during the same session.

Modifier 59:

Modifier 59 appends when the healthcare provider performs joint aspiration on two different minor or major joints, such as if arthrocentesis performs on an elbow joint or a hip joint, the healthcare provider will code 20610 and 20610-59.

Modifier LT:

Use modifier LT when the procedure is performed on the left limb joints.

Modifier RT:

Modifier RT appends when the procedure is performed on the joints of the right limbs.

Examples of 20610:

A 50-year-old patient with knee osteoarthritis visits an orthopedic clinic. The healthcare professional injects a corticosteroid into the patient’s knee as a therapeutic procedure to reduce pain and inflammation.

CPT Code: 20610- Arthrocentesis, aspiration and/or injection, major joint or bursa

Modifiers: None

Diagnosis Codes: M17.11- Unilateral primary osteoarthritis, knee

A 45-year-old patient visits a rheumatologist to seek treatment for chronic elbow bursitis. The healthcare provider injects a corticosteroid into the inflamed olecranon bursa to alleviate pain and inflammation.

CPT Code: 20610- Arthrocentesis, aspiration and/or injection, major joint or bursa

Modifiers: RT

Diagnosis Codes: M70.31- Olecranon bursitis, right elbow

A 40-year-old patient visits an emergency department after an injury with acute shoulder pain and inflammation. To get the diagnosis, the physician performs arthrocentesis to extract the fluid from the injured left shoulder joint.

CPT Code: 20610- Arthrocentesis, aspiration and/or injection, major joint or bursa

Modifiers: LT

Diagnosis Codes: S43.401A- Strain of muscle, fascia, and tendon of the rotator cuff, left shoulder, initial encounter

Frequently asked questions About CPT Code 20610

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