Payment should be made for needling of a bursa, including an adventitious bursa, under the appropriate arthrocentesis code. This includes injection of carpal tunnel, heel spur, ganglion cyst and Baker's cyst. Arthrocentesis or needling of bursa performed in connection with the fingers or toes, e.g., interphalangeal, metacarpal-phalangeal or metatarsal-phalangeal joints, should be reported under procedure code 20600.

Services performed in connection with the hand, foot, wrist (carpal tunnel) or ankle, e.g., carpal-metacarpal, tarsal-metatarsal, carpal or tarsal joints including the heel (heel spur) should be reported under procedure code 20605.

Claims reporting arthrocentesis or injection of the sacroiliac joint should be reported and paid under procedure code 20610.

Arthrocentesis reported for other areas of the spine, i.e., cervical, dorsal, lumbar, lumbosacral or coccyx should be processed as injection of trigger points (procedure codes 20552, and 20553). (For guidelines on trigger points, see Medical Policy Bulletin S-7.) However, when a doctor reports his services as arthrocentesis by fluoroscopy, the service should be processed under the appropriate procedure code for arthrocentesis of the type joint involved. Itemized charges should be combined and processed under the appropriate arthrocentesis code.

Except for local anesthetics, reimbursement for the cost of the drugs or biologicals used in the injection is allowed in addition to reimbursement for the procedure.  Use the appropriate code for the drug or biological administered.

NOTE:

For guidelines on intra-articular injections of hyaluronan (Synvisc or Hyalgan) for osteoarthritis of the knee, see Medical Policy Bulletin G-25.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.