Do THERAPEUTIC ARTHROGRAMS exist?

amexnikki23

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Hi. A group of us has been going back and forth on this for what seems like forever. Here is the scenario (which contains sub-scenarios).

Patient having steroid injection in major joint (we'll go with the knee for purposes of all being on the same page).

- Provider performs an arthrogram to evaluate contrast/needle placement
- Injects contrast for the arthrogram
- Fluoroscopy for the athrogram
- Injects steroid into the knee joint for pain after contrast/needle placement confirmed via arthrogram.

Possible coding scenarios.

-20610 (steroid injection)
-27370 (injection for arthrogram contrast)
-77002 (fluoroscopy)
-73580 (radiological interpretation of arthrogram)
-Q9967 (contrast)
-Jxxxx (steroid)

Now some of us are saying that the provider should bill 20610, 77002, JXXXX and cannot bill the 27370/73580/77002 at all because a diagnostic arthrogram simply was not performed. A diagnostic arthrogram would be to diagnose, and not to evaluate contrast or confirm needle placement prior to a joint steroid injection.

Others believe the provider can bill the 27370/73580/77002/JXXXX/Q9967 only... and not the 20610 (in other words, one or the other).

One says that while the provider cannot bill the 27370/73580 they can still charge for the contrast if they did in fact, do an arthrogram (even if it was done for contrast flow eval/needle confirmation).

Yet others say they can bill it all!

WHAT SAY YOU?????
 

mhstrauss

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Hi. A group of us has been going back and forth on this for what seems like forever. Here is the scenario (which contains sub-scenarios).

Patient having steroid injection in major joint (we'll go with the knee for purposes of all being on the same page).

- Provider performs an arthrogram to evaluate contrast/needle placement
- Injects contrast for the arthrogram
- Fluoroscopy for the athrogram
- Injects steroid into the knee joint for pain after contrast/needle placement confirmed via arthrogram.

Possible coding scenarios.

-20610 (steroid injection)
-27370 (injection for arthrogram contrast)
-77002 (fluoroscopy)
-73580 (radiological interpretation of arthrogram)
-Q9967 (contrast)
-Jxxxx (steroid)

Now some of us are saying that the provider should bill 20610, 77002, JXXXX and cannot bill the 27370/73580/77002 at all because a diagnostic arthrogram simply was not performed. A diagnostic arthrogram would be to diagnose, and not to evaluate contrast or confirm needle placement prior to a joint steroid injection.

Others believe the provider can bill the 27370/73580/77002/JXXXX/Q9967 only... and not the 20610 (in other words, one or the other).

One says that while the provider cannot bill the 27370/73580 they can still charge for the contrast if they did in fact, do an arthrogram (even if it was done for contrast flow eval/needle confirmation).

Yet others say they can bill it all!

WHAT SAY YOU?????


Great info in this previous thread--I even have a reference from Supercoder.com there!!

https://www.aapc.com/memberarea/forums/134343-20610-77002-vs-23350-77002-a.html
 

amexnikki23

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Thanks for the link to the other thread!

Meagan, thanks for the link! The information from the other post was very informative. It is beginning to make more sense and get us closer to a unanimous opinion, however, there is still that one nagging question (which was asked by "kivbar" on the other thread) and that is what actually constitutes a true arthrogram? I'm not sure that just stating there are permanent records is enough documentation. To me, it needs to be a diagnostic arthrogram and not just a contrast eval/confirmation of needle placement.

Radiologyinfo.org states that "Arthrography is medical imaging used to help evaluate and diagnose joint conditions and unexplained pain. It is very effective at detecting disease within the ligaments, tendons and cartilage. It may be indirect, where contrast material is injected into the bloodstream, or direct, where contrast material is injected into the joint. Arthrography may use computed tomography (CT) scanning, magnetic resonance imaging (MRI) or fluoroscopy – a form of real-time x-ray... In some cases, local anesthetic medications or steroids may be injected into the joint along with the contrast material. These medications may temporarily decrease joint-related pain or inflammation and provide physicians additional information about possible sources of joint pain."

So even though in some cases, a local anesthetic may be injected, this still appears to be for diagnostic purposes, and not therapeutic even though it may decrease pain, the intent is still an attempt to identify the source of the pain; therefore, in my opinion, unless the documentation specifically states that the joint injection (for pain) was performed along with an arthrogram (done for diagnostic purposes) then it seems that injection of contrast for arthrogram and arthrogram R&I code would be inappropriate and only the joint steroid injection (and fluoro if used) should be coded.
 
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