Post Arthrogram versus Fluro Guidance Please Help


Best answers
My physicians are debating whether coding for an arthrogram injection is correct or not or whether the coding should be large joint with fluro guidance.
The doctors start by injecting 1/2 cc of contrast, once confirmed in the joint space (shoulder, hip, etc), they infiltrate with between 10-12cc of lidocaine, celestone, etc and then do an xray read.

For a shoulder would it be appropriate to code 23350, 73040 with the medications or do you have to code 20610, 77002 and the medications??

Thank-you in advance for your replies and any explanations I may pass on to them.
Best answers
z health publishing is an excellent source for radiology exams. I would say it is a joint injection because no diagnostic imaging was done. Sounds like a therapuetic injection. 20610, 77002

4.Do not code for arthrography when injection of contrast into the joint is for localization purposes, for confirmation of needle tip location, or when contrast is injected for the purpose of CT or MR arthrography.
5.Complete documentation of a contrast arthrogram is needed to allow coding the diagnostic arthrogram S&I code listed above. A request or order should be available for coding a radiographic arthrogram.

Joint aspirations and injections are routinely performed procedures that are coded based on anatomic region. These are straight forward exams with image-guided placement of a needle into the joint space for fluid aspiration and/or injection. The injections usually consist of a combination of steroids and anesthetic agent such as Lidocaine or Marcaine.

3.Codes 77002, 77012, and 77021 are appropriate for use with aspiration codes 20600, 20605, and 20610 if fluoroscopic, CT, or MRI guidance for needle placement is documented.

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance 20610