CPT Code 20610: A Comprehensive Guide
Description: Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.
When it comes to medical billing and coding, understanding the various CPT codes is crucial. One such code is CPT code 20610. In this article, we will provide you with all the necessary information about this code, including its description, approximate fee amount, insurance guidelines, and usage.
CPT Code 20610: Description
CPT code 20610 is used to represent a specific procedure in the medical field. In this case, it refers to the aspiration and/or injection of a major joint or bursa, such as the knee, shoulder, or hip. This procedure is commonly performed to relieve pain and inflammation in these areas.
Approximate Fee Amount
Fee: $64.12
The fee for CPT code 20610 can vary depending on several factors, including the geographic location, the healthcare provider, and the insurance coverage. On average, the fee for this procedure ranges from $100 to $500. However, it is important to note that these are just approximate figures and the actual fee may differ.
Insurance Guidelines
Documentation Requirements: It’s crucial that the patient’s medical record supports the medical necessity of the procedure, including detailed medical history, results of relevant diagnostic tests, and documented symptomatology reduction if treatment is repeated (CMS.gov).
Modifiers: Commonly used modifiers include JW (if part of the drug is wasted), RT, LT, and 50 (for bilateral procedures) to indicate the specific details of how and where the procedure was
performed .
Payer Specific Guidelines: Insurers might have specific guidelines, including the necessity for prior radiological exams and documentation supporting the initial diagnosis. The application of modifiers and billing separate line items for bilateral procedures can vary among commercial payers and should align with Medicare or other insurance requirements .
CPT Code 20610: Guidelines and Usage
Modifier Use: For unilateral procedures, the RT or LT modifiers are used. If the procedure is bilateral, modifier 50 is recommended. Modifier JW is applicable if there is any drug wastage during the procedure.
Medicare Considerations: For Medicare billing, any associated drug should also be included on the claim, and the medical necessity must be documented as per Medicare guidelines. The drug code is billed separately using the JW modifier .
Coding Guidelines
The aspiration and/or injection procedure code may be billed in addition to the drug. Indicate
which knee was injected by using the RT (right) or LT (left) modifier (FAO-10 electronically) on
the injection procedure (CPT 20610). Place the CPT code 20610 in item 24D. If the drug was
administered bilaterally, a -50 modifier should be used with 20610.
Annual code updates-Added J7325, Deleted J7322; Added Per JSM 09414 08-13-09 new
instructions for hospital billing of Synvisc-One: For services provided between February 26,
2009, through December 31, 2009, contractors shall instruct hospitals to bill for Synvisc-One
using three (3) units of the Healthcare Common Procedure Coding System (HCPCS) Code J7322
(Hyaluronan or derivative, Synvisc, for intraarticular injection, per dose). The instructions for
billing NOC codes (J3490 and C9399) have been removed. All settings should bill Synvisc-One as
3 units of code J7322.