Q&A: Billing for arthrocentesis

December 5, 2008
Virginia Martin, CPC, CHBC

The author, president of Healthcare Consulting Associates of N.W. Ohio Inc., has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assi

To receive payment for arthrocentesis and related procedures, attach a modifier –59 to the successive services.

We perform arthrocentesis in our office and understand that codes 20600–20610 may only be reported one time during the encounter. We also perform 20612 aspiration and injection of ganglion cysts, and we understand that we can bill for this procedure multiple times during the same encounter. But our claims are being rejected. Are the criteria for 20600-20610 the same as 20612?

The criteria are different, and you are billing the service correctly, according to the Current Procedural Terminology. To achieve payment, however, you must attach the modifier –59 to the successive services. As we know, CPT definition is only part of the issue. The insurer receiving your claims may not allow billing of the service multiple times during the same session. You may wish to contact your provider rep if that is the case and dispute the rejections on the basis of divergent criteria from CPT.