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May Coding Q&A

May 30, 2017

Got coding questions? Your Academy has the answers. Each month we feature a member’s question with an answer provided by AAPM&R’s Reimbursement and Policy Review Committee (RPRC).

Q: When performing injections, is it appropriate to bill separately for ultrasound guidance when performed?

A: In the case of some CPT® codes for injections, it is appropriate to bill separately for ultrasound guidance while other injections have a CPT code that is bundled with the ultrasound guidance.

CPT Code 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection and localization device), imaging supervision and interpretation, is an appropriate code for certain procedures when performed. In these cases, the primary injection code is billed in addition to 76942 for ultrasound guidance.

The following is a list of common injection codes for which ultrasound guidance should be reported and billed separately:

  • 20526 Injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel
  • 20550 Injection(s); single tendon sheath or ligament, aponeurosis (e.g., plantar “fascia”)
  • 20551 Injection(s); single tendon origin/insertion
  • 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
  • 20553 Injection(s); single or multiple trigger points), 3 or more muscles
  • 20612 Aspiration and/or injection of ganglion cyst(s) any location
  • 64450 Injection, anesthetic agent; other peripheral nerve or branch
  • 64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g., Morton’s neuroma)

However, there are a number of codes for which ultrasound guidance is bundled. This means that it is considered an inherent part of the injection service and cannot be separately billed. The value of the ultrasound guidance is built into the reimbursement for the code. 

Examples of these codes include:

  • 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa; with ultrasound guidance, with permanent recording and reporting
  • 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
  • 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording

In the case of code 27096 for injection procedure for sacroiliac joint, anesthetic/steroid, with imaging guidance (fluoroscopy or CT) including arthrography when performed, imaging is bundled with the code for the procedure. However, as is indicated in the code descriptor, the bundled imaging is limited to fluoroscopy or CT. For sacroiliac joint injections with ultrasound guidance, the ultrasound needle guidance code (76942) may be used and it is recommended to use the 20551 code for the injection, as 27096 may not be used with ultrasound guidance.

Find additional resources related to reimbursement here. Do you have a coding or billing question? Contact AAPM&R at codingquestions@aapmr.org for assistance. 

Accurate coding is the responsibility of the provider. This article is intended only as a resource to assist in the billing process.