# Arthrogram and Flouroscopy question



## raechelz (Dec 7, 2010)

Hello everyone,

In the CIRCC study guide it states to bill the injection procedure, the flouro and the CT or MRI with contrast.  The flouroscopy is always denied as inclusive of the CT per the CCI edits.  My thought is to append the 59 but I am struggling that it doesn't seem like a different session.  Yes they go from the flouro room to the CT or MRI room but it is all the same appointment.

What are your recommendations?  Also I take the CIRCC test Saturday so any words of advice would  be welcomed.

Thank you,

Raechel
Colorado


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## kbazarte@yahoo.com (Dec 7, 2010)

the codes that we utilize are:

23350 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder    
          arthrography

73040 Radiologic exam, shoulder arthrography. radiological S & I

these codes include the flouro guidance


I am also taking (re-taking) the CIRCC on saturday.  Time is of the up most importance, more so than the CPC.  The op notes are LONG and there are ALOT of them.  I let the time get away from me the first time then rushed through the rest of the test.  If you have op notes to practice with I highly suggest that you do.  REALLY know your coding rules for both interventional and cardiac cath.  Make very good notes in you CPT book especially by codes that have special rules ( ie. Renal angio during cardiac cath G0275 ) Know your vascular families, arch anatomy to include bovine and variant.  

Good luck on saturday, if you want any other helpful hints or have other question my email is kell.bazarte@trinityhealth.org


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## raechelz (Dec 8, 2010)

Thank you for your post.  I had tried to email you a few times today but it keeps coming back undeliverable.  I was thinking when i take the test i might run though it and answer those i know first and then hit the hard ones.  I worry though that may take more time than I think.  What attack plan do you have?

Do you have the circc study guide?  There is a section that states if you are doing an arthrogam with CT or MRI you are to code the correct CT or MRI with contrast for the area.  Is the study guide even helpful?

Thanks,

Raechel


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## Sheila1112 (Dec 9, 2010)

According to CSI Navigator for Diagnostic Radiology:
"A CT arthrogram (or MR Arthrogram) is performed after intra-articular (within the joint) contrast injection.  A CT arthrogram is coded as a CT scan with contrast.  In addtiion, the contrast injection should be coded.  If fluoroscopy is used to guide the injection, code 77002 can also be reported.  However if conventional arthrogram is performed (for example, 73040 for shoulder arthrogram) in addition to CT arthrogram (or MR), fluoroscopy cannot be reported as it is considered a component of the conventional arthrogram."

I hope this helps.


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## kbazarte@yahoo.com (Dec 9, 2010)

just noticed i miss spelled my own email address it is kelly.bazarte@trinityhealth.org.

I do have the CIRCC study guide and it is helpful.  If you have access to the Dr. Z's interventional coding reference that is also very helpful, I used to call it my coding bible when I was still an interventional tech.  The study guide gives the CPT codes and Do's and Dont's where the Z book explains the procedure as well as gives examples.  Also the online CIRCC practice exam is helpful and it gives rationals to the questions which helps explain the "why" of what you answered wrong.

time is of the very up most important with this exam.  On the CPC there were only a few long op notes, but the test there are only a few SHORT op notes.

My strategy for taking the test is to answer all the questions I can answer without hesitation.  My next pass through will be those that only have a few codes in the answer.  I will save the longest op notes with the most codes in the answer for last.  It is very probalbe that I will leave a few unanswered on the test but I would rather leave a copule blank and get more right than rushing and getting more wrong.

please feel free to email with any questions, I left the CORRECT email this time :O)


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