Orthopedic Coding Alert

Question: What is the appropriate CPT code for a medial epicondyle injection with a diagnosis of medial epicondylitis? Should I use 20605 or 64450?

Massachusetts Subscriber  
Answer: Based on the information you provided, 20605 (arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) is the correct choice, linked with ICD-9 code 726.31 (medial epicondylitis). The description of the code, taken from the Medicare Carriers Manual, leaves little doubt that this is correct for your case. After administering a local anesthetic, the physician inserts a needle through the skin and into a small joint, bursa or ganglion cyst. A fluid sample may be removed from the joint or a fluid may be injected for lavage or drug therapy. The needle is withdrawn and pressure applied to stop any bleeding. Report 20605 if an intermediate joint, bursa or ganglion cyst is injected.
 
For 64450 the manual states, The physician anesthetizes a nerve to provide pain control or blockage. This code is used only when no other procedure is applicable. Based on that reading, 20605 is the right code.