Radiology Question for the Week of November 19, 2018


I would like a second opinion on billing for a limited extremity ultrasound (US) and an aspiration with US guidance. These are documented on the same report without separation. I feel that although the criteria for a limited 76882 are met (i.e., imaging of the joint and showing effusion), the procedure is really performed for needle placement, which would make it inclusive. Could you please review the report below and give me your opinion?

CLINICAL INDICATION: Effusion, left ankle
TECHNIQUE AND FINDINGS: Preprocedural imaging demonstrated a small effusion in the anterior and lateral tibiotalar joint. An appropriate skin entry site was identified and marked using ultrasound guidance. The risks and benefits of the procedure were explained to the patient and informed consent was obtained. The patient was then prepped and draped in the usual sterile fashion. A timeout procedure was performed. Local anesthesia was achieved with 1% lidocaine. Using ultrasound guidance, 22-gauge needle was advanced into the anterior tibiotalar joint and a total of 1 mL of Kenalog 40 and 1 mL of 1% lidocaine was injected. The needle was then removed. The patient tolerated the procedure well and there were no postprocedural complications.
IMPRESSION: Successful ultrasound-guided injection of the left tibiotalar joint as detailed above.


Ultrasound used for localization and guidance of an injection is not separately reported as a diagnostic exam, and only CPT code 20606 is reported.

20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting

Chapter 9, Section H–General Policy Statements, item 9, of the 2018 National Correct Coding Initiative Policy Manual for Medicare Services states the following:

Evaluation of an anatomic region and guidance for a needle placement procedure by the same radiologic modality on the same date of service may be reported separately if the two procedures are performed in different anatomic regions. For example, a physician may report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement…) when performed in different anatomic regions on the same date of service. Physicians should not avoid edits based on this principle by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service.

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