# arthrogram  vs Therapeutic injection



## Shirleybala (Jun 19, 2009)

Should we need to code this procedure as 23350 or 20610 

      The anterior left shoulder was prepped and draped in the usual
       sterile fashion.  Following local anesthesia with one percent
       lidocaine, a 20 gauge spinal needle was introduced into the
       glenohumeral joint using fluoroscopic guidance.  3 cc of omnipaque
       240 was injected intra-articularly, confirming the intra-articular
       location of the needle tip.  This was followed by injection of 8
       cc of a dilute gadolinium mixture (.1 cc of gadolinium in 20 cc of
       sterile saline).  40 mg of Depo-Medrol and 5 cc of 0.5% and
       bupivicaine were also injected intra-articularly.  The patient
       tolerated the procedure well.  No complications were encountered.
       He was sent for subsequent MR examination.

       Impression:

       Left shoulder gadolinium arthrogram prior to MR examination.

       Therapeutic injection of Depo-Medrol and bupivicane into the left
       glenohumeral joint.


----------



## msncoder (Jun 22, 2009)

Shirley,
  The report did not provide evidence that this was a true diagnostic arthrogram therefore I would say the most appropriate CPTs in this case would be 20610 and 77002 however if the report had documented images post-injection (eg. shoulder was exercised after injection and views showed....) then you could charge 23350 (and 73040 for RS&I). CPT 20610 is more of a generic code for major joints and would include injections and/or aspirations but you also have to remember that it has a lower RVU. 
Also, don't forget to charge the MRI as w/IV contrast (73222).


----------



## Shirleybala (Jun 23, 2009)

Thank you


----------



## Poodles (Jul 22, 2009)

msncoder said:


> Shirley,
> The report did not provide evidence that this was a true diagnostic arthrogram therefore I would say the most appropriate CPTs in this case would be 20610 and 77002 however if the report had documented images post-injection (eg. shoulder was exercised after injection and views showed....) then you could charge 23350 (and 73040 for RS&I). CPT 20610 is more of a generic code for major joints and would include injections and/or aspirations but you also have to remember that it has a lower RVU.
> Also, don't forget to charge the MRI as w/IV contrast (73222).



Actually, the injection sounds more like a 23350 to me.  The procedure states "injection procedure for shoulder arthrogram OR enhanced CT/MRI shoulder arthrography".  Your patient was escorted to the MRI suite for an MRI of the shoulder, you have contrast injected into the shoulder FOR the arhtrogram.  

Patti Downing, RCC


----------

