Radiology Coding Alert

Question: Which joint injection codes can we report when our physician uses fluoroscopic guidance for the procedure? The new joint injections codes 20604, 20606, and 20611 specify an injection with ultrasound guidance. On the contrary, we have other options (20600, 20605, and 20610) which specify joint injections with no imaging. Which one is the best choice?

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Answer: You should specifically report code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with any of the following injection codes:

• 20600 – Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); without ultrasound guidance
  
• 20605 – Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
  
• 20610 – Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance.
  

Modifier: You may also need to append modifier 51 (Multiple procedures) to the injection code, depending on the circumstances.

Watch before you report ultrasound: If your provider performs an intra-articular joint injection with ultrasound that qualifies for one of the new codes, you won’t report the ultrasound guidance because it’s included in the service. Those codes are:

• 20604 – Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); with ultrasound guidance, with permanent recording and reporting
• 20606 – Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting
  
• 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.

If your physician provides the joint injection with fluoroscopic, CT, or MRI guidance rather than ultrasound guidance, you’ll submit the applicable “old” injection code: 20600, 20605, or 20610. CPT® directs you to also report 77002, 77012 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation), or 77021 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation), as appropriate.

Edit info: CCI edits bundle the fluoroscopic, CT, and MRI image guidance codes into the new codes for joint injection with ultrasound. You can possibly bypass the bundling edits with a modifier, but only if your provider performs the image guidance with a different procedure than the joint injection with ultrasound.