Wiki 20610 - to modifier 52 or not???

kobusk

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My Dr. notates:
"...Procedure: Under sterile conditions, attempted fluid aspiration of the left knee bursa could not get any fluid in return. No bleeding noted. Patient tolerated the procedure well."

Should this be coded as 20610-52 (since no fluid was aspirated)? Or just 20610 since all of the work required for the procedure was performed?

Not sure that there is a definite "right or wrong" answer and I wasn't able to find any references from various sources (AAOS, CPT Asst, etc.). Any opinions and/or references are appreciated. Thanks.

Ken
 
I wouldn't bill it with a 52 modifier. The doctor still has to go through the entire procedure in order for them to find out if there is going to be any fluid. Hope this helps.
 
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