Orthopedic Coding Alert

Question: Our orthopedist performed an arthrocentesis injection on a patient's left ring finger proximal interphalangeal (PIP) joint with guidance. How should I report this encounter?

Idaho Subscriber

Answer: You need to know which type of guidance the orthopedist used for the injection. If he used ultrasound guidance, report 20604 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting) for the service.

If, however, your orthopedist uses fluoroscopic, computed tomography (CT), or magnetic resonance imaging (MRI) for visualization, your coding will change.

First: Regardless of whether it's fluoroscopic, CT, or MRI for visualization during the arthrocentesis, you'll report 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance) for the injection.

Second: Report one of the following codes for the guidance, depending on the specifics of the encounter:

• +77002- Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)
• 77012- Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
• 77021- Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation.

Remember: If your practice doesn't own the guidance equipment the provider uses during the arthrocentesis, you might need modifier 26 (Professional component) to indicate that you are only coding for your provider's services, and not the equipment she used for visualization.