Wiki Radiologist code

[markamanda111@gmail.com]

I have a radiologist who wants to bill 27093 for hip arthrogram. Local anesthetic and contrast dye were injected under fluroscopic guidance. Dye for the purpose of outlining the joint to diagnose a labral tear. Is that code 27093? And wouod it be code 73525 for the MRI arthrogram or 73722? Also the radiologist is wanting to bill this under revenue code 0360 but that is hospital operating room fees. The procedure was done on outpatient basis at an outpatient clinic. His rationale is 27093 can be interpreted as surgical in nature due to the needle piercing the skin so he wants to bill this as minor surgery even though it is supposed to be just a straight MRI hip arthrogram. I worry code 0320 should be used if any revenue code at all as this is diagnostic radiology.

Can anyone offer insight?

Here is the radiology report below. I am mainly confused if it should be coded 73525 or 73722 or 77002? And I feel odd coding 27093 with a revenue code
of 0360 as an OR procedure.

“FL ARTHROGRAM 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; Fluoro 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 The needle was withdrawn and a sterile dressing applied.”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.

 

[markamanda111@gmail.com]

You need to find out what the ordering protocol is for this exam and if your facility bundles in the fluoroscopic guidance of the injection of the Gad into the MRI charge. Technically, what is happening is two separate exams. The rad is using the fluro machine to localize the injection of Gad into the joint space. However, it is not a true arthrogram because the rad did not perform the rest of the imaging sequences to get a diagnosis of a tear/pathology. The patient was sent to MRI for those images to confirm/deny the tear/pathology. Arthograms are not done under fluoroscopy anymore, just the injection of contrast material.

1. • 27369 - Arthrogram, hip, radiological supervision and interpretation - this code was used before CT/MRI arthrograms became the gold standard.
   • 77002 - Fluoroscopic guidance for needle placement - this might be the code the rad was thinking of, but check to see how this is billed out constantly in your facility. Every place is different.

Thank you for this. When you say ordering protocol do you also mean the intention of what the purpose of the procedure was? This was a diagnostic for labral tears, etc.

Also can the radiologist actually bill this using revenue code 0360 and as a surgical practice in an OR? That seems a little bit of stretch but he feels 27093 is a outpatient surgical procedure and really wants to use that code with 77002 and 72722 as I cited before. I have trouble with calling the fluroscopic injection a surgical procedure done in an OR when this is an outpatient radiology centre . Very different from an actual OR and what is done there. I feel it is almost overbilling and skewing the procedure to a degree so this is why o am uncomfortable.

I should also add this is a hip arthrogram as the patients orders had it written, whereas 27369 as you cited , is for knee as I understand.

Sorry if I am a little confused!

 

[markamanda111@gmail.com]

First off, I am a Radiology/MRI/CT/OR tech who codes. I know the names of procedures, not CPT codes for procedures, so yes, this information pertains to all arthrograms, hips, knees, and shoulders. Ordering protocols are what coders know as a "global package," meaning everything that is included in the procedure, including needle placement, the procedure tray, and contrast. For instance, my arthrogram protocol starts with me setting up the fluro room for the procedure (the injection tray, sterile field, and the contrast to be injected for the study), and the rad injects the contrast, I then take the patient to a different room and scan them. That is it, no images other than needle placement were taken. It is not surgery by any stretch of the imagination. The rad does not manipulate the joint space under fluoroscopy to get a diagnosis, which would be a true fluro arthrogram (I did those back in the day). Your rad wants to upcharge, and that is fraud.

This is definitely my worry too. So if you had to hypothetically code this whole procedure what would your codes be? Would you include the OR revenue code 0360? As you mentioned also I feel that is fraud. And 27093 seems to not fit anymore since a full hip arthrogram was not done and patient went to the MRI. The Fluoroscpy was just done to inject the contrast.

 

[markamanda111@gmail.com]

73525 = $120.98
77002 = $110.30

He is making a big deal over $10.68

So these are the only two codes you would report? See this was originally my thought also. This OR and surgery theory is really pushing it. I fully concur with all you say. Thank you so so much.

 

[markamanda111@gmail.com]

Thank you so much for this. So you would not use code 27093 at all is this right? This is the one the radiologist is pushing to be coded as outpatient surgery and I am very very uncomfortable with this . The MRI I believe would be 73525. And the injection the 77002.

Originally they wanted me to code
73722
73525
27095
And then the pharmacy drug codes
Iodine Q9966, etc.


You have been so helpful.