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Official Description

Injection of sinus tract; diagnostic (sinogram)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Injection of sinus tract, designated by CPT® Code 20501, refers to a diagnostic procedure known as a sinogram. This procedure is primarily utilized to assess sinus tracts within the musculoskeletal system, which often arise due to complications from puncture wounds that become infected or as a result of osteomyelitis following injuries such as open fractures or surgical interventions. During the diagnostic process, a sterile catheter is carefully inserted into the sinus tract. This insertion is performed under radiographic supervision, which is a separate reportable service. The key objective of this procedure is to inject a contrast material into the sinus tract, allowing for radiographic imaging to visualize and evaluate the size and location of the sinus tract. This diagnostic approach is crucial for determining the appropriate treatment plan and understanding the underlying issues associated with the sinus tract.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

Injection of sinus tract (CPT® Code 20501) is indicated for the following conditions:

  • Sinus Tracts These are abnormal channels that can develop in the musculoskeletal system, often resulting from infections or complications following injuries.
  • Infected Puncture Wounds Sinus tracts may arise from puncture wounds that have become infected, necessitating diagnostic evaluation.
  • Osteomyelitis This condition, characterized by bone infection, can lead to the formation of sinus tracts, making diagnostic imaging essential for treatment planning.
  • Post-Surgical Complications Following surgical procedures, sinus tracts may develop, requiring assessment to determine the extent of the issue.

2. Procedure

The procedure for the injection of sinus tract involves several critical steps to ensure accurate diagnosis and effective imaging.

  • Step 1: Preparation The area surrounding the sinus tract is prepared and sterilized to minimize the risk of infection during the procedure. This preparation is crucial for maintaining a sterile environment.
  • Step 2: Catheter Insertion A sterile catheter is carefully inserted into the sinus tract. This step is performed under radiographic supervision, which is essential for guiding the catheter to the correct location within the tract.
  • Step 3: Contrast Injection Once the catheter is in place, a contrast material is injected through the catheter. This contrast agent is vital for enhancing the visibility of the sinus tract during radiographic imaging.
  • Step 4: Radiographic Imaging After the contrast is injected, radiographic images are taken to visualize the sinus tract. This imaging allows for the assessment of the size and location of the tract, providing critical information for diagnosis.

3. Post-Procedure

Following the injection of the sinus tract, patients may be monitored for any immediate reactions to the contrast material. It is important to observe for signs of infection or complications at the injection site. The results from the radiographic imaging will be analyzed to determine the appropriate next steps in management or treatment. Patients may be advised on any necessary follow-up appointments or additional diagnostic procedures based on the findings from the sinogram.

Short Descr INJECT SINUS TRACT FOR X-RAY
Medium Descr INJECTION SINUS TRACT DIAGNOSTIC
Long Descr Injection of sinus tract; diagnostic (sinogram)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) I1F - Standard imaging - other
MUE 2
CCS Clinical Classification 159 - Other diagnostic procedures on musculoskeletal system
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
LT Left side (used to identify procedures performed on the left side of the body)
MH Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT Right side (used to identify procedures performed on the right side of the body)
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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