Arthrocentesis or needling of a bursa may be considered medically necessary when ALL of the following criteria are met:
- "Conservative therapy (rest area and avoid activity, cryotherapy, compression dressings, elevation of affected area above heart, other modalities like electrical stimulation/ultrasonography/phonophoresis, NSAIDs, or steroids) to control pain and inflammation has failed; and
- Affected area continues with symptoms of severe pain along with swelling and inflammation; and
- Movement of joint remains limited due to pain; and
- The response to therapy must be documented for medical review prior to additional therapy authorizations.
*Conservative therapy is considered a failure of treatment if no improvement or resolution of pain within four (4) weeks from the start of therapy.
When a doctor reports his services as arthrocentesis by fluoroscopy, the service should be processed under the appropriate procedure code for arthrocentesis of the type of joint involved. Itemized charges should be combined and processed under the appropriate arthrocentesis code.