Joint diseases are one of the most common ailments in orthopedics. Both young and old people suffer from them. In fact, more than 200,000 people in the United States experience bursitis annually.
Despite the easy access to treatment procedures, many healthcare practices struggle with their billing. A frequently used billing code among these is CPT code 20610. You have probably arrived at this guide because you have faced a denial for this code.
Don’t worry, read our guide to learn how you can effectively use this code in your billing without errors. So, let’s start.
CPT Code 20610 – Description
CPT code 20610 is defined as:
“Arthrocentesis, aspiration, and/or injection of a major joint or bursa without ultrasound guidance.”
Sounds hard? Let’s simplify it for you. 20610 is a billing code that is commonly used in orthopedic and rheumatology practices. It basically represents a pain management procedure.
To clear any confusion, let’s briefly discuss what happens during the procedure.
Under 20610, the physician inserts an injection needle into a major joint or bursa. Via the injection, the physician then removes the fluid from a joint (aspiration) or injects therapeutic substances into the joint. Please note that both of these actions can be done during the same session.
20610 is not specific to a single joint. It can be used for numerous joint types, such as:
- Shoulder joint
- Hip joint
- Knee joint
And the subacromial bursa.
The code can be used for both pain relief and diagnostic purposes. A key point to note here is that CPT code 20610 is used for procedures that do not require the use of ultrasound. When ultrasound guidance is used, providers should report CPT code 20611 instead.
Appropriate Use Cases for CPT Code 20610
Still not clear? Don’t worry. We will explain the accurate application of CPT code 20610 with the help of some real-world scenarios.
Managing Shoulder Osteoarthritis with Corticosteroid Injection
Suppose a 60-year-old man comes to an orthopedic clinic. He has had severe right shoulder pain that has worsened over the past six months. He shares with the physician that he has already tried conservative treatments like non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy, which another physician prescribed. However, they only had a minimal effect.
The physician orders imaging tests, which show moderate osteoarthritis in the shoulder. Based on the diagnosis, the physician decides to administer a corticosteroid injection to reduce inflammation. So, the physician carefully places the needle in the glenohumeral joint and administers the drug.
In this case, the billing department can bill the injection via CPT code 20610 and modifier RT.
Bilateral Knee Injections for Arthritis Management
Let’s consider another scenario.
Suppose that a 65-year-old woman has osteoarthritis in both her knees. This makes it difficult for her to move. The physician carefully assesses her condition, and after reviewing multiple treatment options, he decides to perform corticosteroid injections in both knees during the same visit.
In this case, the billing department can use CPT code 20610 with modifier 50 to bill the procedure.
Modifiers to Append with CPT Code 20610
The following modifiers can be used with CPT code 20610:
| Modifier | Description | Application |
|---|---|---|
| 50 | Bilateral Procedure | Apply to CPT 20610 when performing arthrocentesis on both sides in the same session. |
| LT | Left Side Procedure | Use when the procedure is performed on the left joint. |
| RT | Right Side Procedure | Use when the procedure is performed on the right joint. |
Reimbursement Guidelines for CPT Code 20610
Follow these billing best practices to avoid code 20610-related claim denials.
Document Everything
Appending the correct and relevant documentation is the most vital part of medical billing. Provide detailed documentation that justifies the medical necessity of the procedure and explains the circumstances in which the procedure was performed. The following are some essential things to mention:
- Specific joint or bursa treated (e.g., “tibiofemoral and/or patellofemoral joints of the right knee” rather than just “knee”).
- Clinical indication and symptoms necessitating the procedure.
- Proof of failed initial conservative treatment.
- Medication type and dosage administered.
- Pre-procedure patient symptoms, such as pain level, swelling, and range of motion limitations.
- Procedural details, including needle size, injection technique, and patient response.
- Post-procedure instructions and follow-up plans.
Follow the Medication Billing Requirements
A vital point that many billers miss when filing claims for CPT code 20610 is that the code covers the procedural work only, and does not include the cost of medications injected. You will have to bill for the drugs separately via the appropriate HCPCS code.
Knee arthrocentesis or injection administration is frequently performed. For intra-articular knee injections, you can find appropriate HCPCS codes in the CMS guide.
Check the Medicare Reimbursement Rate
The reimbursement rate for code 20610 differs by payer and Medicare Administrative Contractor (MAC) locality. However, Medicare’s national average reimbursement in facility settings is $43.99 and $63.40 in non-facility settings.
You can check the exact amount for your MAC locality via the PFS Lookup Tool.
Final Thoughts on CPT Code 20610
So, there you have it, the complete description of CPT code 20610. Let’s recap everything we discussed in this guide.
20610 is an orthopedic billing code and is used for arthrocentesis, aspiration, and/or injection of a major joint or bursa, such as the shoulder, hip, or knee, without ultrasound guidance. For proper reimbursement, you must provide detailed documentation and append the appropriate modifiers to your claim.
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