How To Use CPT Code 20606

CPT 20606 refers to arthrocentesis, aspiration, and/or injection of intermediate joints or bursae with ultrasound guidance, permanent recording, and reporting. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 20606 procedures.

1. What is CPT 20606?

CPT 20606 is a medical procedure code used to describe arthrocentesis, aspiration, and/or injection of intermediate joints or bursae with the use of ultrasound guidance, permanent recording, and reporting. This procedure is performed to relieve pain and swelling in the affected joint or bursa, as well as to diagnose potential infections or inflammation by examining the synovial fluid.

2. 20606 CPT code description

The official description of CPT code 20606 is: “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.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider inserts a needle through the skin and into the intermediate joint or bursa, such as the temporomandibular, acromioclavicular, wrist, elbow, ankle, or olecranon bursa.
3. Under ultrasound guidance, the provider uses a syringe with the needle to remove fluid from the joint or bursa.
4. The provider permanently records the findings and reports them.
5. The fluid sample is sent to the laboratory for further examination.
6. If necessary, the provider may inject a drug into the joint or bursa for therapeutic purposes, such as pharmacotherapy or lavage.
7. The needle is removed, and pressure is applied to stop any bleeding.

4. Qualifying circumstances

Patients eligible to receive CPT 20606 services are those experiencing pain, swelling, or other symptoms in intermediate joints or bursae, such as the temporomandibular, acromioclavicular, wrist, elbow, ankle, or olecranon bursa. Additionally, the procedure may be performed as a diagnostic aid for suspected infections or inflammation in the joint or bursa.

5. When to use CPT code 20606

It is appropriate to bill the 20606 CPT code when the provider performs arthrocentesis, aspiration, and/or injection of an intermediate joint or bursa with ultrasound guidance, permanent recording, and reporting. This code should only be used for intermediate-sized joints or bursae, and not for smaller or larger joints.

6. Documentation requirements

To support a claim for CPT 20606, the following information should be documented:

• Patient’s medical history and symptoms related to the affected joint or bursa
• Physical examination findings
• Indication for the procedure
• Details of the procedure, including the joint or bursa involved, use of ultrasound guidance, and any medications injected
• Permanent recording and reporting of the ultrasound findings
• Results of laboratory analysis of the aspirated fluid, if applicable
• Post-procedure care and follow-up instructions

7. Billing guidelines

When billing for CPT 20606, it is essential to ensure that the procedure is performed on an intermediate joint or bursa with ultrasound guidance, permanent recording, and reporting. If the procedure is performed without ultrasound guidance, use code 20605 instead. Do not report CPT 20605 or 20606 in conjunction with 76942. If fluoroscopic, CT, or MRI guidance is performed, see codes 77002, 77012, or 77021.

8. Historical information

CPT 20606 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Similar codes to CPT 20606

Five similar codes to CPT 20606 and how they differentiate are:

• CPT 20600: Arthrocentesis for small joints or bursae without ultrasound guidance
• CPT 20604: Arthrocentesis for small joints or bursae with ultrasound guidance, permanent recording, and reporting
• CPT 20605: Arthrocentesis for intermediate joints or bursae without ultrasound guidance
• CPT 20610: Arthrocentesis for major joints or bursae without ultrasound guidance
• CPT 20611: Arthrocentesis for major joints or bursae with ultrasound guidance, permanent recording, and reporting

10. Examples

1. Arthrocentesis of the temporomandibular joint with ultrasound guidance to diagnose and treat temporomandibular joint disorder
2. Aspiration of an acromioclavicular joint with ultrasound guidance to relieve pain and swelling due to arthritis
3. Injection of a corticosteroid into the wrist joint with ultrasound guidance for treatment of wrist synovitis
4. Arthrocentesis of the elbow joint with ultrasound guidance to diagnose and treat septic arthritis
5. Aspiration of an ankle joint with ultrasound guidance to relieve pain and swelling due to gout
6. Injection of a therapeutic agent into the olecranon bursa with ultrasound guidance for treatment of olecranon bursitis
7. Arthrocentesis of the temporomandibular joint with ultrasound guidance to diagnose and treat an infection
8. Aspiration of an acromioclavicular joint with ultrasound guidance to diagnose and treat adhesive capsulitis
9. Injection of a corticosteroid into the wrist joint with ultrasound guidance for treatment of carpal tunnel syndrome
10. Arthrocentesis of the elbow joint with ultrasound guidance to diagnose and treat rheumatoid arthritis