Orthopedic Coding Alert

Question: My doctor conducted an aspiration of a cyst in the back of the right knee using ultrasound to guide an injection used during the operation. My gut is telling me to bill for 20550 to include the injection, but would that also cover the ultrasound guidance for the cyst aspiration?

Kentucky Subscriber

Answer: The code to use in this situation is 20611 (Arthrocentesis, aspiration and/or injection, major joint or bursa [e.g., shoulder, hip, knee, subacromial bursa]; with ultrasound guidance, with permanent recording and reporting). Code 20611 is a comprehensive code that includes the aspiration of a major joint with the add on of using ultrasound to guide the operation.

It may be easy to assume the code would be 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]), especially since it includes the billing of injection, but this would be incorrect. Code 20550 is not nearly comprehensive enough include the larger aspiration and the ultrasound. In this case, do not use code 20550.

A question to ask about injections when billing can help clarify coding confusion. First, ask your provider if the injection to help ease the pain of a patient. If the provider can answer yes to this question, then the injection was not necessarily essential to the operation. This means that there is no way to bill for the injection. In this case, using the more comprehensive 20611 code, which covers the ultrasound and the aspiration, is ideal.

Remember: In situations like this, identify what is essential to the operation. Ask yourself if the injection is necessary for the aspiration to be successful and then adjust your code accordingly. This should help you prioritize billing and make coding a little easier.