Wiki “Intention “ in radiology billing

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markamanda111@gmail.com

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A question I have to ask is, when performing radiology billing, is the idea of intention of the imaging ( ie , performing a hip MRI with contrast to diagnose a labral tear, etc) taken into account when assigning CPT codes?

For example if an orthopedic surgeon gives re patient an order for an MRI with contrast of the hip joint to diagnose labral tears, osteoarthritis, etc., would this not be coded as a diagnostic image procedure?

I am being told to bill an outpatient radiology MRI with contrast as a surgical procedure done in an OR and I feel that is wrong.
Codes used are 73525 and 27093 and 72722 and then the pharmacy drugs ( Q9966 for iodine and then lidocaine also). I am uncomfortable with 27093 and the idea of this being a surgery.

The radiologist is saying anytime he puts a needle to the skin and breaks it it is considered an outpatient surgery in the OR using code 27093.

I should say the injection of lidocaine and contrast was only to view the joint. The patient was sent to the MRI machine afterwards for images.
 
Was it an arthrogram of the hip or a conventional MRI?

If it's an arthrogram of the hip, the 73525 (radiologic examination, hip, arthrography) and 27093 (injection procedure for hip arthrography, without anesthesia) would be appropriate. (With anesthesia would be 27095.)

I'm by no means an orthopedic clinician, but from what I can see an arthrogram might be more likely used to diagnose a tear vs a conventional MRI:


There is no CPT 72772 - is there a typo in that code?
 
sls314 said:
Was it an arthrogram of the hip or a conventional MRI?

If it's an arthrogram of the hip, the 73525 (radiologic examination, hip, arthrography) and 27093 (injection procedure for hip arthrography, without anesthesia) would be appropriate. (With anesthesia would be 27095.)

I'm by no means an orthopedic clinician, but from what I can see an arthrogram might be more likely used to diagnose a tear vs a conventional MRI:


There is no CPT 72772 - is there a typo in that code?
Click to expand...
Hi there. It was an MRa for the hip. So hip arthrogram but I felt 27093 was not proper as the images were taken by the MRI machine and no fulsome diagnoses with an X-ray or pictures with X-ray were taken after the lidocaine and contrast were injected . That is why I thought 73525.

Sorry I meant 73722 was the original code with 27093 and 73525 but you cannot bill 73722 and 73525 together actually.

What gets me is how on earth does the radiologist think this can be explained as an outpatient surgery done in an OR and calling the fluroscopic suite an OR? It seems to be a stretch or am I missing something. I feel I would be overbilling.

They also want me to add on 77002 now.
 
markamanda111@gmail.com said:
Hi there. It was an MRa for the hip. So hip arthrogram but I felt 27093 was not proper as the images were taken by the MRI machine and no fulsome diagnoses with an X-ray or pictures with X-ray were taken after the lidocaine and contrast were injected . That is why I thought 73525.

Sorry I meant 73722 was the original code with 27093 and 73525 but you cannot bill 73722 and 73525 together actually.

What gets me is how on earth does the radiologist think this can be explained as an outpatient surgery done in an OR and calling the fluroscopic suite an OR? It seems to be a stretch or am I missing something. I feel I would be overbilling.

They also want me to add on 77002 now.
Click to expand...

CPT code 27093 refers to an injection procedure. While it falls within the surgical range, many other injection codes do as well. It’s important to understand that in CPT terminology, a "surgical" code doesn’t necessarily indicate a procedure performed in an operating room.

Do you have a CPT book? Reviewing the codes in it may help clarify these concepts.

Additionally, fluoroscopic guidance (77002) is bundled into 73525, meaning it cannot be billed separately. The description of 73525 already includes fluoroscopic guidance.

I don't have my CPT book with me today, but here's a screenshot from EncoderPro for 73525. (I highlighted the references for 27093 and 77002 for you):


1741292243884.png
 
Keep in mind that I'm not looking at your documentation, so I can't say whether a hip injection was done. (Seems logical that they'd inject the contrast for an arthrogram, but you'd have to confirm in the documentation.)

Read the lay description below from EncoderPro and see if that helps your understanding of what the 27093 procedure is. If the injection was done, it is valid for billing with the 73525.

1741292577670.png
 
thank you. Yes my issue is the radiologist is actually using revenue code 0360 ( an OR in a hospital) even though this was in an outpatient setting with no OR even near. And then using 27093 to explain why he is using the OR code stating he did a surgery and the injection is considered an outpatient surgical procedure to justify it.
 
sls314 said:
Keep in mind that I'm not looking at your documentation, so I can't say whether a hip injection was done. (Seems logical that they'd inject the contrast for an arthrogram, but you'd have to confirm in the documentation.)

Read the lay description below from EncoderPro and see if that helps your understanding of what the 27093 procedure is. If the injection was done, it is valid for billing with the 73525.

View attachment 7821
Click to expand...
This is the exam notes. In your opinion how would you code this and does the 27093 justify? Again my issue is the radiologist saying this was done in an OR and using revenue code 0360 as well as 27093 and saying it is a surgery because he injected dye and injection = surgical procedure. I really feel it might be a stretch even ethically.

HIP RIGHT


Collected on 1/8/2025


Resulted on 1/8/2025


Authorized by Provider Not In System


Resulting Agency: POWERPH


Narrative


EXAM: Fluoroscopically guided arthrogram, right hip arthrogram COMPARISON: 5/3/2023 INDICATION: M16.31


Unilateral osteoarthritis resulting from hip dysplasia, right hip 110 fluro time: 0.1 Images: 2 Pt states continued right hip pain. TECHNICAL: Written and verbal consent were obtained from the patient following discussion of the risks and benefits of the procedure including but not limited to bleeding, infection, and nerve injury. A timeout was performed. The patient was placed on the fluoroscopy table. The injection site was identified under fluoroscopic guidance. The site was prepped and draped in a sterile fashion. Approximately 1 mL of lidocaine was utilized to anesthetize the skin and subcutaneous tissues. The needle was advanced into the right hip joint under fluoroscopic guidance. Approximately 12 mL of a mixture of diluted gadolinium contrast and 0.25% bupivacaine was infused under fluoroscopic guidance. The needle was withdrawn and a sterile dressing applied.


Impression


1. Successful fluoroscopically guided right hip arthrogram.


Fluoroscopic time 0.1 minutes. 2 fluoroscopic images obtained. No immediate post procedure complication. The patient was immediately transferred to MRI arthrography. 2.


As above.
 
sls314 said:
Keep in mind that I'm not looking at your documentation, so I can't say whether a hip injection was done. (Seems logical that they'd inject the contrast for an arthrogram, but you'd have to confirm in the documentation.)

Read the lay description below from EncoderPro and see if that helps your understanding of what the 27093 procedure is. If the injection was done, it is valid for billing with the 73525.

View attachment 7821
Click to expand...
Essentially this is what he originally wanted to bill even trying to cite the lidocaine as full blown anesthesia. I am in disagreement so now he wants to use 27093 but still put HC and claim it under OR revenue code 0360 and then use 77002 and 73722. My issue like I said is this was not an outpatient surgery in an OR and it seems to be not right. But again I want to double check as maybe I am missing something.

Magnetic Resonance Imaging


HC MRI Lwr Ext Jnt W/Contrast - 73722


(CPT®I




Operating Room Services


HC Inj Arthrogram Hip Anes - 27095


(PT®)




Pharmacy


Bupivacaine Pf 0.25 % (2.5 Mg/MI) Soln


(0409-1159-01) - quantity: 20 - J0665 (HCPCS)


Bupivacaine Pf 0.25 % (2.5 Mg/MI) Soln


(0409-1159-01) - quantity: 30 - J0665 (HCPCS)


lohexol 240 Mg lodine/MI Soln (0407-


1412-29) - quantity: 2 - Q9966 (HCPCS)


Gadobutrol 2 Mmol/2 MI (1 Mmol/MI)


Soln (50419-325-37) - quantity: 10 -


A9585 (HCPCS)





Radiology - Diagnostic


C Xr Arthrogram Hip - 73525 (CPT®)
 
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