CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2
ICD-10: M17.0
Coding Rationale
The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a bilateral procedure. Some insurance carriers require the CPT codes to be submitted with an LT/RT modifier while others accept the -50 modifier on the second code. Every insurance carrier has its individual guideline, and it’s important to know which billing requirement is accepted prior to submitting the claim.
The drug code J7326 is for hyaluronan or derivative, Gel-One, for intra-articular injection per dose. Two doses were administered, and this should be reflected on the claim. The lidocaine is not billable, because it is an integral part of the injections.
The ICD-10 code M17.0 is for bilateral primary osteoarthritis of knees. The code descriptor already lists the diagnosis as bilateral, so no additional ICD-10 code is needed for clinical validation.
When a patient is scheduled for a procedure, no evaluation and management visit should be coded for the visit, unless it is medically necessary. If a history is taken and a limited examination is done specifically related to the injection, the office should only code for the arthrocentesis injections because the limited evaluation of the patient is built into the RVUs of the procedure.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at [email protected] or call 404-633-3777 x820.
