Orthopedic Coding Alert

Question: Encounter notes indicate that the provider performed X-rays on a patient’s left shoulder and elbow. The shoulder X-ray was via arthrography, and the provider used fluoroscopic guidance for needle placement. The elbow X-ray was also performed via arthrography, but the provider did not use fluoroscopic guidance for needle placement. How many units of +77002 should I include to represent needle placement for these X-rays?

Montana Subscriber

Answer: None. Neither of the codes you describe is available for use with add-on fluoroscopic guidance code +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)). In fact, under the descriptor for +77002, CPT^® states: “77002 is included in all arthrography radiological supervision and interpretation codes.”

Do this: For this encounter, report:

• 73040 (Radiologic examination, shoulder, arthrography, radiological supervision and interpretation) for the shoulder X-ray.
• 73085 (Radiologic examination, elbow, arthrography, radiological supervision and interpretation) for the elbow X-ray.

Modifier LT (Left side) appended to 73040 and 73085 to indicate laterality, if the payer requires it.

When to use +77002: If you needed any more proof that you shouldn’t use +77002 in this instance, the CPT^® entry for 73040 reads “Do not report 77002 in conjunction with 73040”; the CPT^® entry for 73085 reads “Do not report 77002 in conjunction with 73085.”