Amazing guide for Cpt code for arthrogram coding

Basics of arthrogram coding, code MRI post arthrogram joint cpt with contrast
Arthrography(Photo credit: Wikipedia)

Basics About CPT code for Arthrogram

An arthrogram is a procedure performed by utilizing x-rays to obtain a series of images of a joint that has been injected with contrast material. In this procedure, a fluoroscope is used to take pictures of the joint.

Under fluoroscopic guidance, a needle is inserted into the joint cavity (of the hip, shoulder, ankle, sacroiliac, wrist, etc.). Once the position of needle is confirmed with the injection of contrast (it can be a dye or a combination of both dye and air used for a double-contrast arthrogram) medium, the physician removes some of the joint fluid and sends it to the laboratory. The needle is then removed and any minor bleeding is controlled.  The injection is normally done under a local anesthetic. The radiologist performs the exam using fluoroscopy or ultrasound guidance to guide the placement of the needle into the joint and then injects an appropriate quantity of contrast. The physician or technologist then obtains a series of x-rays or alternatively CT (computerized tomography) scans or MRI (Magnetic resonance imaging) scans. The joint can be images form many angles in fluoroscopy or on a slice by slice basis in CT or MRI scans. Shoulder arthrography is used mainly to study tears of the rotator cuff. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam.

CPC Practice Exam - Medical Coding Study Guide Please Click Here!

Clinical Scenario:

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

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).

Read also: What is Global Period? 

 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 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). Don't try to report 77002 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 77002 instead of the S&I arthrogram code.

EXAM: CT GUIDED ARTHROGRAM OF THE RIGHT HIP

HISTORY: Evaluate for labral tear. Right hip pain for 4 weeks limiting the patient from running.

TECHNIQUE: The risks and benefits of the procedure were explained to the patient and written consent was obtained. The area of injection was localized under CT guidance and the area was prepped and draped in sterile fashion. Local anesthesia with buffered lidocaine was administered to the superficial tissues. A 22 gauge needle was introduced into the right hip joint and approximately 10 ml of contrast mixture (0.1 mL of Magnevist gadolinium, 5 mL of Omnipaque 350, 5 mL of 0.2% ropivacaine, 10 mL of saline) was injected. The patient tolerated the procedure well. No evidence of complications.

FINDINGS: Contrast is seen flowing into the right hip joint.

The preprocedural pain level was 2-3/10 at rest and slightly increased with hip flexion adduction and internal rotation. The pain was similar or less with hip flexion abduction and external rotation.

IMPRESSION: Successful injection of contrast into the right hip joint. Final results will be interpreted with MR arthrogram to follow.
CPT- 27093, 77012-26

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