How To Use CPT Code 20604

CPT code 20604 describes the procedure of arthrocentesis, aspiration, and/or injection in a small joint or bursa, such as the fingers or toes, with the use of ultrasound guidance, permanent recording, and reporting. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 20604?

CPT code 20604 is used to describe the procedure of arthrocentesis, aspiration, and/or injection in a small joint or bursa, specifically in areas like the fingers or toes. This procedure involves the use of ultrasound guidance, permanent recording, and reporting. The provider inserts a needle through the patient’s skin into the joint or bursa, and then uses a syringe to remove fluid or inject medication into the joint for therapeutic purposes. Arthrocentesis not only relieves pain and swelling but also serves as a diagnostic aid, allowing the provider to examine the synovial fluid in the joint for signs of infection or inflammation.

2. Official Description

The official description of CPT code 20604 is: ‘Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes) with ultrasound guidance, with permanent recording and reporting.’

3. Procedure

During the procedure of CPT code 20604, the provider follows these steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider inserts a needle through the patient’s skin into the small joint or bursa, typically in the fingers or toes.
3. Under ultrasound guidance, the provider uses a syringe attached to the needle to remove fluid from the joint or bursa.
4. The provider permanently records the findings.
5. If necessary, the provider sends the fluid sample to the laboratory for further examination.
6. The provider may also inject medication into the joint or bursa for therapeutic purposes, such as pharmacotherapy or lavage.
7. After completing the procedure, the provider removes the needle and applies pressure to stop any bleeding.

4. Qualifying circumstances

CPT code 20604 is applicable when the provider performs arthrocentesis, aspiration, and/or injection in a small joint or bursa, such as the fingers or toes, using ultrasound guidance, permanent recording, and reporting. It is important to note that this code should not be reported in conjunction with codes 76942, 0489T, or 0490T. If the provider uses fluoroscopic, CT, or MRI guidance during the procedure, different codes should be used (77002, 77012, 77021).

5. When to use CPT code 20604

CPT code 20604 should be used when the provider performs arthrocentesis, aspiration, and/or injection in a small joint or bursa, such as the fingers or toes, with the assistance of ultrasound guidance, permanent recording, and reporting. It is important to note that this code is specific to small joints or bursae and should not be used for other joint or bursa procedures.

6. Documentation requirements

To support a claim for CPT code 20604, the provider must ensure the following documentation is included:

• Patient’s diagnosis and the medical necessity for the procedure
• Specific details of the procedure, including the use of ultrasound guidance
• Date and time of the procedure
• Recorded findings and any additional actions taken, such as fluid sample submission or medication injection
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 20604, it is important to ensure that the procedure is performed in a small joint or bursa, such as the fingers or toes, and that ultrasound guidance, permanent recording, and reporting are utilized. It should not be reported in conjunction with codes 76942, 0489T, or 0490T. Additionally, consider the location and guidance used during the procedure to determine the appropriate code to report.

8. Historical information

CPT code 20604 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 20604

There are several similar codes to CPT code 20604, including:

• CPT 20600: Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes) without ultrasound guidance
• CPT 20601: Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa) without ultrasound guidance
• CPT 20605: 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
• CPT 20606: Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) without ultrasound guidance
• CPT 20610: Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) with or without ultrasound guidance

9. Examples

1. A provider performing arthrocentesis, aspiration, and/or injection in a patient’s finger joint using ultrasound guidance, with permanent recording and reporting.
2. A provider performing arthrocentesis, aspiration, and/or injection in a patient’s toe bursa using ultrasound guidance, with permanent recording and reporting.
3. A provider performing arthrocentesis, aspiration, and/or injection in a patient’s finger joint without ultrasound guidance.
4. A provider performing arthrocentesis, aspiration, and/or injection in a patient’s toe bursa without ultrasound guidance.