(2023) CPT Code 20605 | Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 20605 (Section 20600-20611) is related to Arthrocentesis, aspiration, and injections with or without ultrasound guidance.

Summary

Arthrocentesis is a procedure of removal of synovial fluid from joints. It is also known as joint aspiration. CPT codes for arthrocentesis are very significant in medical coding.

These procedure codes in interventional radiology coding depend on the types of joint on which injection or aspiration is performed.

This aspiration procedure diagnoses multiple joint diseases or conditions, e.g., Osteoarthritis, Gout, and intraarticular injections.

The procedure codes for arthrocentesis are divided into three types based on the size of the joints. Joints are divided into small, Intermediate, and major joints. 

Small joints include fingers, toes, etc. 

Intermediate joints have the wrist, elbow, ankle, or TMJ.

Large joints include Knee, Hip, shoulder, etc.

Description Of The CPT Code 20605

The official description of the 20605 CPT code is: “Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance.”

After giving a local anesthetic, the physician inserts a needle through the skin and into a joint or bursa. Fluid is taken as a sample from the joint for examination, or fluid may be injected for lavage or drug therapy. The needle is pulled out, and pressure is applied to stop the bleeding. 

Without ultrasound guidance, 20600 for arthrocentesis of a small joint or bursa, such as the fingers or toes.

Report 20604 for arthrocentesis of a small joint or bursa, with ultrasound guidance, including permanent record and information; Without ultrasound guidance.

Report CPT code 20605 for an intermediate joint or bursa, such as the wrist, elbow, ankle, TMJ, or acromioclavicular area.

Billing Guidelines

Do not report the ultrasonic guidance (76942) separately. When documentation indicates fluoroscopic, CT, or MRI guidance is performed, note these services separately using the appropriate CPT code (77002, 77012, 77021).

These codes should be registered only once, even if an aspiration and injection are performed during the same session. Local anesthesia is included in these services. To register imaging guidance, see 77002, 77012, and 77021. Should not report Ultrasonic tip (76942) with CPT code 20605. May report supplies with the appropriate HCPCS Level II code for physician offices. Check with the specific payer to determine coverage.

CPT code 20605 recommends reporting only a single unit for each joint treated, nonetheless of how many injections or aspirations occur in a single joint.

Modifier LT or modifier RT may be appropriate when reporting codes for joint arthrocentesis, aspiration, or injection procedures. 

Must report the appropriate HCPCS Level II J code if medication is administered. You must write different codes if the procedure is performed on multiple joints.

According to new billing guidelines, only two units per visit of CPT 20605 are allowed to be billed.

Cost and Relative value units of the facility services:

The Cost and total RVUs of CPT code 20605 are $37.72 and 1.09000, respectively, for National and Global Facility Services.

Cost and Relative value units of the Non-facility services:

The Cost and total RVUs of CPT 20605 are $56.06 and 1.62000

respectively for both National and Global Non-Facility Services.

Facility codes reflect the volume and ferocity of the facility’s resources to provide care.

According to Centers for Medicare & Medicaid guidelines, Always report two units of 20605 when the injection is introduced on two different sites. When the site is the same, but the procedure is performed bilaterally, bill CPT code 20605 with modifier 50 and use only one unit(e.g., both knees). Non-Medicare payers have different rules for reporting a bilateral procedure.

Should report the appropriate HCPCS Level II J code if medication is injected.

Report an E&M (evaluation and management) service with the aspiration, arthrocentesis, or injection codes provided the service is significant and different from the procedure. Modifier 25 When another minor or major procedure is performed, a Separate identifiable Evaluation and Management service is carried out on the Same Day by the Same Physician or Other Qualified Health Care Professional.

Should not report a separate Evaluation and Management service if the patient reports to the office strictly for aspiration, arthrocentesis, or injection procedure.

How To Use Modifiers With CPT Code 20605

Modifiers provide additional information about the medical procedure, service, or supply involved without changing the meaning of the code.

Modifiers that are applicable with CPT code 20605 are given below:

Modifier 50 with Example

50 Modifier— Bilateral procedures.

Bilateral procedures are performed on both left and right sides of the body.

This modifier is used as a payment modifier instead of an informational modifier. Never use modifier 50 when the bilateral surgery indicator is 0, 2, or 9. Depending on the procedure code and the bilateral surgery indicator, this modifier may affect payment.

Billing Example

A patient came to the hospital orthopedic department and reported bilateral ankle pain. The doctor wants to take a fluid sample (aspiration) from both ankle joints. After giving a local anesthetic, the physician inserts a 25-gauge needle through the skin and into the ankle joint.

A fluid sample was removed from the joint for examination, or fluid may be injected for lavage or drug therapy. The needle was then withdrawn and applied pressure to stop any bleeding. A bilateral procedure is performed in this scenario, so append modifier 50 with CPT code 20605 and use only one billing unit.

20605–50–X1

Modifier 51 with Example

Multiple procedures: More than one procedure is performed at the same provider’s session. 

Never use on E&M services, Add-on codes.

Billing Example

During the same operative session, an orthopedist surgeon performed a closed treatment of a femoral shaft fracture on the right leg and a fluid aspiration procedure on the left ankle. In these circumstances, two different CPTs are used with modifier 51 appended to one CPT in conjunction with LT or RT.

Modifier 59 with Example

Distinct procedural services—Under specific circumstances, it is necessary to specify that a service or procedure was separate from other non-Evaluation and Management services provided on the same day.

Modifier 59 is used to determine benefits, other than E&M services, that are not reported together but are appropriate under different circumstances. 

Documentation must support a different site or organ system, extra session, other procedure or surgery, separate lesion, separate incision or excision, or separate area of injury not ordinarily encountered on the same day by the same person. 

If no more descriptive modifier is available, modifier 59 best explains the circumstances.

Billing Example

An orthopedist surgeon performed total knee arthroplasty and Arthrocentesis, aspiration of the ankle without ultrasound guidance on the same day. So these are distinct procedures and cannot be billed together on the same day without any modifier. In this case, modifier 59 is required to override this relationship.

Modifier 76 with Example

Repeated procedure Done by Same Physician or Other Qualified Health Care Professional.

It is essential to indicate that a service was repeated by the same physician or other qualified health care professional following the original procedure. In this case, append modifier 76 to identify it as a repeated procedure.

Billing Example

A doctor performed procedure 20605 on the elbow joint; the patient returned after two days to repeat the same procedure. In this case, append modifier 76 with one CPT 20605.

Modifier 77 with Example

Procedure Repeated by Another Physician or Other Qualified Health Care Professional.

It is necessary to indicate that a procedure was repeated by another physician or other qualified healthcare professional following the original method or service. May report this by adding modifier 77 to the repeated treatment procedure.

Billing Example

A Physician performed an Arthrocentesis of the wrist joint in the afternoon, and another physician repeated the same service in the evening. In these circumstances, always use modifier 77 with one CPT.

Modifier 78 with Example

An Unplanned Patient returned to the operating room and was treated by the same Initial physician, and the same procedure was done during the Postoperative Period.

Billing Example

The patient was brought to the recovery room status post total hip replacement. Dressings became saturated; vital signs were unstable. The patient was carried back to the operation theatre to explore postoperative hemorrhage. 

Modifier 79 with Example

An Unplanned Patient returned to the operating room for treatment of an unrelated condition by the same physician, and the same procedure was done during the Postoperative Period.

The individual needs to indicate that the performance of a procedure or service during the postoperative period was unrelated to the previous service. In these circumstances, append modifier 79 with the previously done service.

Billing Example

A physician performed CABG (90-day global period) on 13th Jan 2022. On 23rd Feb, the same physician performed procedure 20605. So, in this case, always append modifier 79 to the unrelated procedure performed within the global fee period.