What is the proper use of CPT (Current Procedural Terminology) 20600 for arthrocentesis?

Proper Use of CPT 20600 for Arthrocentesis

CPT code 20600 is used for arthrocentesis, aspiration, and/or injection of small joints or bursa (e.g., fingers, toes) without ultrasound guidance. 1

Indications for CPT 20600 Use

• Arthrocentesis of small joints (fingers, toes) is indicated for diagnostic evaluation of suspected septic arthritis, crystal-induced arthritis, or other inflammatory joint conditions 1, 2
• Joint fluid aspiration should include analysis for total cell count, differential leukocyte count, crystal analysis, and culture for aerobic and anaerobic organisms when clinically indicated 1
• Therapeutic injection of small joints may be performed for pain relief and inflammation reduction 3, 4

Procedural Requirements

• Proper sterile technique must be used, including sterile gloves, skin preparation, and sterile equipment 1
• If ultrasound guidance is used, single-use sterile probe covers and sterile gel packets should be employed 1
• The procedure should be documented with:
  • Pre-procedure diagnosis
  • Description of the procedure
  • Joint or bursa accessed
  • Medication injected (if applicable)
  • Post-procedure diagnosis 1, 4

Coding Distinctions

CPT 20600 is part of a family of arthrocentesis codes that are differentiated by joint size:

• 20600: Small joints or bursa (e.g., fingers, toes)
• 20604: Small joints or bursa with ultrasound guidance
• 20605: Intermediate joints or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa)
• 20606: Intermediate joints with ultrasound guidance
• 20610: Major joints or bursa (e.g., shoulder, hip, knee, subacromial bursa)
• 20611: Major joints with ultrasound guidance 1, 4

Clinical Considerations

• Plain radiographs should be obtained prior to arthrocentesis when evaluating for osteomyelitis, septic arthritis, or soft tissue infection 5, 1
• For suspected septic arthritis, withhold antibiotics for at least 2 weeks prior to arthrocentesis if clinically feasible to increase the likelihood of recovering an organism 1
• Blood cultures should be obtained if fever is present, symptoms have acute onset, or bloodstream infection is suspected 1, 2

Documentation Requirements

• Document informed consent
• Record pre-procedure diagnosis
• Note the specific joint or bursa aspirated
• Document the amount of fluid obtained and its characteristics
• Record any medication injected (type, dose, lot number)
• Document any specimens sent for laboratory analysis
• Note any complications 1, 4

Common Pitfalls to Avoid

• Failing to distinguish between tendon calcification and bursal calcification, which may require different treatment approaches 1
• Incorrect coding based on joint size (using 20600 for intermediate or large joints) 4
• Inadequate documentation of medical necessity for the procedure 4
• Not sending appropriate laboratory tests when diagnostic arthrocentesis is performed 1, 2