CPT code 20611 is for draining or injecting a joint or bursa with ultrasound guidance.
CPT code 20611 is for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa using ultrasound guidance. This code specifically indicates that the procedure was performed with the assistance of ultrasound to ensure accuracy and effectiveness.
For CPT code 20611 (Drain/inj joint/bursa w/us), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided on the same day as the procedure and is distinct from the procedure itself.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body during the same session.
3. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
4. Modifier RT: Right side. Use this modifier to specify that the procedure was performed on the right side of the body.
5. Modifier LT: Left side. Use this modifier to specify that the procedure was performed on the left side of the body.
6. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the same procedure was repeated on the same day by the same provider.
7. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. Use this modifier if the same procedure was repeated on the same day by a different provider.
8. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for a related procedure.
9. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. Use this modifier if the procedure is unrelated to the original procedure performed.
10. Modifier XS: Separate structure. Use this modifier to indicate that a service was performed on a separate organ/structure.
11. Modifier XE: Separate encounter. Use this modifier to indicate that a service was performed during a separate encounter.
12. Modifier XP: Separate practitioner. Use this modifier to indicate that a service was performed by a different practitioner.
13. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
Medicare does reimburse for CPT code 20611, which refers to the drainage or injection of a joint or bursa with ultrasound guidance. The reimbursement amount can vary based on geographic location and other factors, but as of the latest data, the national average reimbursement rate for this procedure is approximately $150. It's important to verify the exact reimbursement rate with your local Medicare Administrative Contractor (MAC) as rates can fluctuate and may be subject to specific billing guidelines and conditions.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 20611 for joint or bursa injections with ultrasound. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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