The Current Procedural Terminology (CPT) code 20610 identifies a common orthopedic procedure involving the insertion of a needle into a major joint space or a bursa. This medical service, referred to as arthrocentesis, is performed by healthcare providers to either remove fluid or deliver medication directly to the affected area. The code applies specifically to procedures conducted on large anatomical structures without the use of ultrasound guidance for needle placement.
Defining the Medical Service
The procedure covered by CPT 20610 involves two closely related actions: aspiration and injection. Aspiration requires using a needle and syringe to withdraw accumulated fluid from the joint space or bursa. Conversely, an injection delivers therapeutic agents directly into the same anatomical structure. Both aspiration and injection, or a combination of both, are covered under this single code when performed during one encounter.
The term “major joint” typically refers to the knee, shoulder, or hip, which are the most common sites for this intervention. Major bursae, such as the subacromial bursa in the shoulder, are also included under this classification. Before the needle insertion, the healthcare provider meticulously cleanses the skin with an antiseptic solution to minimize the risk of infection. A local anesthetic is often administered to numb the immediate area, which helps ensure patient comfort during the brief procedure.
Diagnostic and Therapeutic Applications
For diagnostic purposes, fluid is aspirated from the joint and sent to a laboratory for synovial fluid analysis. This analysis is performed to identify the cause of joint swelling and pain, such as the presence of crystals that confirm a diagnosis of gout or pseudogout. Testing the fluid for white blood cell count, Gram stain, and culture is also performed to rule out a serious joint space infection, known as septic arthritis.
In a therapeutic application, the procedure aims to reduce pain and inflammation directly at the source. The most common therapeutic agent delivered is a corticosteroid, often combined with a local anesthetic for immediate pain relief. These medications work by suppressing the local inflammatory response within the joint or bursa. This direct delivery method provides a temporary but often substantial reduction in symptoms for conditions like severe osteoarthritis or bursitis.
Patient Experience and Recovery
Patients rarely need to fast before the procedure, but they may be advised to temporarily stop taking blood-thinning medications. The procedure itself is typically very quick, often taking less than five minutes from skin preparation to the application of a small bandage.
Following the procedure, patients can expect some localized soreness at the injection site for the first 24 to 48 hours. It is recommended to limit strenuous activity and heavy lifting with the affected joint for about one to two days. If a corticosteroid was injected, a temporary increase in pain, known as a post-injection flare, may occur hours after the anesthetic wears off. Patients are instructed to monitor the site for signs of infection, such as increasing redness, warmth, or fever, and to contact their physician immediately if these symptoms develop.