Radiology Coding Alert

Find out which hip code to report with anesthesia.

When traditional joint X-rays don’t show the details needed to make an accurate diagnosis, radiologists can use arthrography to better view the body structure. This procedure involves injecting the patient with contrast media, but unlike some other contrast-related codes, arthrography codes require an extra code for the contrast use. This is why, as a radiology coder, you should stay on your toes for when an arthrography procedure report enters your workflow.

Read on to learn more about arthrography codes and how to properly report the procedures.

Understand Arthrography Examinations

Radiologists have multiple options when it comes to imaging the joints, and arthrography is chosen when the provider needs to examine the joint. Providers use arthrography when they are unable to clearly view the joint’s structure and function with traditional X-rays. An arthrography exam is a series of X-ray images taken of the joint in different positions.

Prior to the examination, the radiologist injects contrast dye into the joint using a long, thin needle. The contrast dye helps certain body structures stand out on the X-rays, so they’re easier to visualize and assess.

Healthcare providers order arthrography exams for several reasons, including:

• Look for ligament, tendon, cartilage, or joint capsule damage or tears
• Examine for loose bodies
• Assess prosthetics
• Check for joint damage caused by repeated dislocations

Typically, providers perform arthrography to examine knee or shoulder joints, but they can also evaluate other joints, such as the elbow, wrist, ankle, and hip, with this process.

Get to Know the Arthrography Codes

The CPT^® code set includes several arthrography codes that differ according to body structure. Below are a handful of arthrography procedure codes:

• 73615 (Radiologic examination, ankle, arthrography, radiological supervision and interpretation)
• 73580 (Radiologic examination, knee, arthrography, radiological supervision and interpretation)
• 73085 (Radiologic examination, elbow, arthrography, radiological supervision and interpretation)
• 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation)
• 73115 (Radiologic examination, wrist, arthrography, radiological supervision and interpretation)

Recognize RS&I: You’ll notice the descriptors for the arthrography codes listed above include the wording, “radiological supervision and interpretation” (RS&I). According to the CPT^® guidelines, all RS&I codes require:

• Permanently recorded image documentation
• Procedure report or separate imaging report containing “written documentation of interpretive findings of information contained in the images and radiologic supervision of the service”

Get to Know the Contrast Injection Codes

The next step is to assign an appropriate code for the contrast injection. Like the arthrography codes, each injection code is tied to the body structure injected, such as the following:

• 27369 (Injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography)
• 27648 (Injection procedure for ankle arthrography)
• 24220 (Injection procedure for elbow arthrography)
• 25246 (Injection procedure for wrist arthrography)
• 27093 (Injection procedure for hip arthrography; without anesthesia)
• 27095 (… with anesthesia)

Code 27369 is designated for a knee arthrography, but you’ll also assign the code if radiologist performs computed tomography (CT) or magnetic resonance imaging (MRI) knee arthrography that’s augmented with contrast. Additionally, 27093-27095 are reserved for hip arthrography contrast injections, but the difference between the two codes relates to whether the provider administers anesthesia prior to the contrast injection.

Sift Through This Hip Arthrography Scenario

Review the following scenario to put your arthrography coding knowledge into practice.

Scenario: A 65-year-old patient is referred to a radiology practice for right hip arthrography. The patient has been suffering from chronic right hip pain for several months. The radiologist performs an arthrography to evaluate the patient’s hip for the cause of the pain. The patient was prepped and anesthetized, then the radiologist injected contrast material into the right hip and captured radiographic images.