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Diagnostic Ultrasound Followed by Ultrasound Guided Injection
We have a Pain Interventionalist performing diagnostic MSK ultrasounds, followed by an ultrasound guided injection. We bill both codes but the claims keep bundling. Is there a way to avoid this?
Question:
We have a Pain Interventionalist performing diagnostic MSK ultrasounds, followed by an ultrasound guided injection. We bill both codes but the claims keep bundling. Is there a way to avoid this?
Answer:
Thank you so much for reaching out with your question. Based on your question, KZA is happy to share the general guidelines for Ultrasound billing with you. An ultrasound-guided injection, for example CPT 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting, involves a focused ultrasound assessment. This includes capturing, labeling, and interpreting images from different angles around the affected area. The goal is to find the best approach for the injection, while noting normal anatomy and any signs of issues. Imaging helps guide the needle safely into the joint or bursa, avoiding bones, blood vessels, and other sensitive structures. Afterward, the findings are carefully documented in the patient’s chart to keep everyone informed. If a diagnostic ultrasound is performed at the same location, it’s included as part of the ultrasound-guided procedure.
If a diagnostic ultrasound is performed at the separate anatomic location, a modifier 59 or X{ESPU} modifier may be appropriate. Please know that this will be under high scrutiny with the payors.
KZA has free KZA KAST podcasts on both modifier 59 and the subset X {ESPU} for additional information on the appropriate application of these modifiers.
Modifier 59 - Part 1
https://monday.transistor.fm/episodes/modifier-59-part-1
Subset Modifier XE
https://monday.transistor.fm/episodes/subset-modifier-xe
*This response is based on the best information available as of 07/09/26.
SI Joint Injection in an ASC Coding
Hi, does Medicare require a different code than 27096 for SI joint injections billed to an ASC?
Question:
Does Medicare require a different code than 27096 for SI joint injections billed to an ASC?
Answer:
Yes. For ASC (Ambulatory Surgery Center) billing, Medicare requires HCPCS code G0260 for facility billing instead of 27096. For professional (physician) billing, use 27096. Remember to always verify payor-specific requirements.
*This response is based on the best information available as of 06/04/26.
Lidocaine and/or Bupivacaine
When billing corticosteroid injection in office, can you bill out lidocaine and/or bupivacaine separately or are they bundled within the injection?
Question:
When billing corticosteroid injection in office, can you bill out lidocaine and/or bupivacaine separately or are they bundled within the injection?
Answer:
Lidocaine and/or bupivacaine are not separately billable when used with a corticosteroid injection in the office. CPT states that local infiltration of anesthesia is included in the global surgical package. CMS states that any anesthesia provided by the operating surgeon is also included.
*This response is based on the best information available as of 05/07/26.
Interspinous Ligament Injection
Our doctor performed a interspinous Ligament injection L3-4 for diagnosis Lumbar interspinous bursitis. I billed 20550 but was not able to code anatomical modifier Lt or RT because it was directly injected into the ligament. Would CPT code 22899 be more appropriate as 20550 requires an anatomical modifier?
Question:
Our doctor performed an interspinous ligament injection L3-4 for the diagnosis of lumbar interspinous bursitis. I billed CPT 20550 but was unable to code the anatomical modifier LT or RT because it was injected directly into the ligament. Would CPT code 22899 be more appropriate, as 20550 requires an anatomical modifier?
Answer:
If an interspinous ligament injection is performed due to bursitis, the correct CPT code would be 20550. Unlisted CPT codes are utilized when a specific CPT code does not exist.
A specific CPT code exists for this procedure therefore, 20550 is used.
*This response is based on the best information available as of 04/02/26.
Nerve Transection CPT 64772
How do I code an AIN and/or PIN Neurectomy?
Question:
How do I code an AIN and/or PIN Neurectomy?
Answer:
You're question is excellent timing. CPT code 64772 Transection or avulsion of other spinal nerve, extradural is used for an AIN and/or PIN Neurectomy. In January 2026, CMS increased the MUE (medically unlikely edit) for 64772 from 2 units to 6 units.
*This response is based on the best information available as of 03/05/26.
CMC Joint Injections
My hospital coder recently told me that I should not bill CMC injections as 20605 but rather 20600. I remember during the conference that 20605 is a justifiable code for thumb CMC joint injections. Can you verify that this is correct and offer me some guidance on what to present to the hospital coder?
Question:
My hospital coder recently told me that I should not bill CMC injections as 20605 but rather 20600. I remember during the conference that 20605 is a justifiable code for thumb CMC joint injections. Can you verify that this is correct and offer me some guidance on what to present to the hospital coder?
Answer:
Thank you for your question. The current guidance, based on an AMA CPT Assistant from August of 2017, is an injection into the CMC joint is 20600.
*This response is based on the best information available as of 02/05/26.
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