Orthopedic Coding Alert

Question: My practice received a denial for a cortisone injection to the sinus tarsi. We reported this with the unlisted code. Did I miss a specific CPT code for this procedure?

California Subscriber

Answer: The correct code for this procedure is hard to pin down because the sinus tarsi is neither a joint nor a ligament but a space. You may consider this a joint, as the sinus tarsi traverses the sub-talar joint, so you should report 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa]).

Your diagnosis will also need to support the appropriate injection code. Surgeons most often use ICD-9 code 726.79 (Enthesopathy of ankle and tarsus; other) to report sinus tarsi syndrome.

Don't forget to use a corresponding J code to gain reimbursement for the drug that the surgeon injected. In the case of cortisone, use J0835 (Injection, cosyntropin, per 0.25 mg).