Radiology Coding Alert

Question: How should I code an MRI or CT arthrogram of the shoulder?


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Answer: The key here is to remember the different components of the arthrogram and that different providers may or may not perform all components on all patients. You may report the intra-articular injection of contrast, the imaging associated with plain film arthrography, and the contrast MRI or CT as appropriate. You may also report the fluoroscopic guidance of the injection - but only if a plain film arthrogram is not performed or reported.

First, choose the appropriate intra-articular injection. For a shoulder arthrogram, report 23350 (Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography).

 Next, select the magnetic resonance or computed tomography code that describes the body part imaged. Example: Choose 73201 (Computed tomography, upper extremity; with contrast material[s]) for CT arthrogram of the shoulder.

If the patient undergoes traditional plain film arthrography as well as CT or MRI arthrography, you can also code the traditional arthrogram. Here, report 73040 (Radiologic examination, shoulder, arthrography, radiological supervision and interpretation) if the radiologist documents a separate traditional contrast arthrogram. Tip: Some practices don't charge for a traditional arthrogram in addition to the CT or MR arthrogram unless the radiologist documents imaging with exercise. But, exercise imaging isn't required for plain film arthrography. All you need is a full and complete set of appropriate plain films after contrast injection and a report of the procedure.

Fluoroscopy report: The codes for traditional arthrogram include use of fluoroscopy to inject the contrast. If your physician does only a CT or MR arthrogram (and doesn't perform or report a plain film arthrogram), you can also report 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). Don't try to report 76003 with 73040 (shoulder arthrography S&I), though, because the two are bundled.

What to do: To use the arthrogram S&I code, you must perform a full and complete radiographic series arthrogram and report those images. For a fluoroscopic- guided injection (without a full and complete radiographic arthrogram) for contrast- enhanced CT arthrography or contrast-enhanced MR arthrography, report 76003 instead of the S&I arthrogram code. The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.; and Gary S. Dorfman, MD, FACR, FSIR.