Guidelines for Arthrocentesis Using CPT Code 20600
CPT code 20600 refers to arthrocentesis (joint aspiration) or injection of a small joint or bursa such as fingers, toes, or temporomandibular joint, which requires specific procedural techniques and sterile precautions to ensure patient safety and diagnostic accuracy. 1
Procedural Requirements
- Transducers used for ultrasound-guided arthrocentesis should be covered with single-use sterile probe covers during the procedure 1
- Single-use sterile gel packets should be used when performing arthrocentesis to prevent infection 1
- Low-level disinfection of ultrasound probes is required between procedures 1
Diagnostic Indications
- Arthrocentesis is indicated when septic arthritis is suspected, receiving a highest appropriateness rating (9/9) from the American College of Radiology 1
- Joint fluid analysis should include total cell count, differential leukocyte count, and culture for aerobic and anaerobic organisms 1
- Crystal analysis should be performed when clinically indicated to diagnose conditions like gout or pseudogout 1, 2
Imaging Guidance Considerations
- Ultrasound guidance can improve accuracy of arthrocentesis, particularly for deeper or difficult-to-access joints 3
- MRI with or without contrast may be complementary to arthrocentesis for evaluation of suspected septic arthritis 1
- Plain radiographs should be obtained prior to arthrocentesis when evaluating for osteomyelitis, septic arthritis, or soft tissue infection 1
Anticoagulation Considerations
- Arthrocentesis can be safely performed in patients receiving therapeutic anticoagulation without the need to reduce anticoagulation levels 4
- A study of 640 arthrocentesis procedures found only 0.2% resulted in significant clinical bleeding in fully anticoagulated patients 4
Post-Procedural Management
- For suspected prosthetic joint infections, withholding antimicrobial therapy for at least 2 weeks prior to arthrocentesis increases the likelihood of recovering an organism 1
- Blood cultures should be obtained if fever is present, symptoms have acute onset, or if bloodstream infection is suspected 1, 2
Therapeutic Applications
- Arthrocentesis alone has been shown to be as effective as arthrocentesis with hyaluronic acid or corticosteroid for pain reduction in temporomandibular joint disorders 5
- Pain reduction of 30-40% can be expected following arthrocentesis procedures 5
Common Pitfalls to Avoid
- Failing to distinguish between tendon calcification and bursal calcification, which may require different treatment approaches 6
- Overlooking small calcifications that may be missed on plain radiographs but visible on ultrasound 6
- Confusing calcific bursitis with joint effusion or synovitis, which can have similar clinical presentations 6