Podiatry Coding & Billing Alert

When your podiatrist treats joint effusion in his practice, you must answer several questions to code the case correctly. First, you must know what part of the foot the effusion is affecting. Also, you must understand the codes for treatment options your podiatrist may pursue.

Answer these questions to keep your effusion claims on the up-and-up in your podiatry practice.

First, Define Joint Effusion for Clarity

Question 1: What is joint effusion?

Answer 1: Joint effusion (not to be confused with joint fusion) is the painful increase of intra-articular fluid within the joint or in the tissues that surround the joint.

Joint effusion can happen in several ways such as inflammation, hematologic conditions, or infections but is usually caused by some type of injury or trauma, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Focus on ICD-10-CM Options for Ankle Effusion

Question 2: Which ICD-10-CM codes can I look to for ankle effusion?

Answer 2: You have the following ICD-10-CM codes for ankle effusion:

• M25.471 (Effusion, right ankle)
• M25.472 (Effusion, left ankle)
• M25.473 (Effusion, unspecified ankle)

Patient Has Effusion of Foot? Do This

Question 3: What ICD-10-CM options do I have for effusion of the foot?

Answer 3: If the patient suffers from effusion of the foot, you should look to the following codes:

• M25.474 (Effusion, right foot)
• M25.475 (Effusion, left foot)
• M25.476 (Effusion, unspecified foot)

Pinpoint Effusion Symptoms

Question 4: What are symptoms of joint effusion?

Answer 4: Effusion may result in pain, swelling, warmth, stiffness, and restricted movement of the joint.

Rely on These Treatment Options for Joint Effusion

Question 5: What are some treatment options for joint effusion?

Answer 5: Providers diagnose joint effusion based upon the patient’s history, including any trauma or disease; a physical exam; and imaging techniques like X rays.

Depending upon the underlying cause, treatment may include administering medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antirheumatics, and antibiotics; the application of moist heat and ice; or joint aspiration.

Understand How to Code Arthrocentesis

Question 6: My podiatrist performed arthrocentesis to treat effusion. Which CPT^® code should I report?

Answer 6: If your podiatrist performs arthrocentesis to treat effusion, you have several procedure codes to choose from. They are as follows:

• 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance)
• 20604 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting). Note: Never report codes 20600 and 20604 in conjunction 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation), 0489T (Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; adipose tissue harvesting, isolation and preparation of harvested cells including incubation with cell dissociation enzymes, removal of non-viable cells and debris, determination of concentration and dilution of regenerative cells), or 0490T (Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; multiple injections in one or both hands).
• 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance)
• 20606 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting). Note: You should never report codes 20605 and 20606 with code 76942.

Arthrocentesis defined: Arthrocentesis is a procedure in which the provider using a needle and a syringe to drain or withdraw fluid from the joint

Differentiate Between Small, Intermediate Bursa and Joint

Question 7: What are the differences between the different arthrocentesis codes — 20600, 20604, 20605, and 20606?

Answer 7: Small joint or bursa: If the notes indicate that your provider injected a small joint or bursa, choose either 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance) or 20604 (… with ultrasound guidance, with permanent recording and reporting). As the descriptors indicate, small joints/bursa include (but are not limited to) fingers and toes.

Intermediate joint or bursa: If the notes indicate that you provider injected an intermediate joint or bursa, choose either 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance) or 20606 (… with ultrasound guidance, with permanent recording and reporting.) As the descriptors indicate, intermediate joints/bursa include (but are not limited to) wrists, elbows, and ankles.

Don’t Forget Modifier 50 on This Claim

Question 8: My podiatrist performed arthrocentesis on the patient’s left and right ankles. They used ultrasound (US) guidance. Do I need to append a modifier to the procedure code?

Answer 8: If you’re reporting the same code for the left and right side of the patient’s body, you should append modifier 50 (Bilateral procedure) to the code. For example, if the notes indicate that your podiatrist performed arthrocentesis aspirations on both of the patient’s ankles with US, report 20606 with modifier 50 appended.