There are new intra-articular joint injections codes, SI arthrodesis issues, rib fracture treatment codes, and some Category III codes that are already causing concerns, just to name a few.

1. Be Compliant with the New CPT® Code Changes
for 2015
Presenter - Margie Scalley Vaught
Orthopedic Coding Updates 2015
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2. CPT 2015 Issues
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3. 2015Sneak Preview
• Injections
– Revised 20600-20610
– Added three new codes
• 20604 Arthrocentesis, aspiration and/or injection,
small joint or bursa (eg, fingers, toes); with ultrasound
guidance, with permanent recording and reporting
• 20606 Arthrocentesis, aspiration and/or injection,
intermediate joint or bursa (eg, 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 (eg, shoulder, hip, knee,
subacromial bursa); with ultrasound guidance, with
permanent recording and reporting

4. Documentation issues
• Per CPT Changes An Insider’s View 2015:
• “Ultrasound: Performed a focus US evaluation.
Obtain, label, and interpret images in multiple
planes through the specific area of concern,
focusing on best approach for injection.
Document the normal anatomic structure and
any pathologic findings. Utilize imaging to
direct the needle to joint or bursa, avoiding
bony prominences, blood vessels, or other
vulnerable structures. Dictate report for the
patient’s chart.”
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5. Now documentation of injection
• Again per CPT Changes An Insider’s View 2015:
• “Shoulder injection: The GH joint can be injected from an
anterior, posterior, or lateral approach. Infiltration local
anesthesia at the injection site, as indicated. Using US guidance,
insert the needle for aspiration and/or injection into the
applicable joint or bursa.
• Anterior approach: Place the needle just medial to the head of
the humerus and 1cm lateral to the coracoid process. Direct the
needle posteriorly and slightly superiorly and laterally.
• Posterior approach: Insert the needle 2cm to 3cm inferior to
the posterolateral corner of the acromion and directed
anteriorly in the direction of the coracoid process.
• Lateral approach: Insert the needle superior and distal to the
affected distal subacromial subdeltoid (SASD) bursal and
supraspinatus and directed laterally to medially into the SASD
bursal space distally.
• FOR ALL APPROACHES: Injection of medication slowly but with
consistent pressure. Visualize the injected medication and joint
distention. Remove the needle.
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6. To see the complete presentation check
the below link:
http://www.audioeducator.com/coding-updates/orthopedic-coding-
updates-2015.html