Orthopedic Coding Alert
Separate Pre-Exam Shot, CT
Question: Encounter notes indicate that the provider performed injection for contrast in a patient’s right knee ahead of a computed tomography (CT) arthrography with contrast material. How should I report this encounter? Can I report the injection separately or is it bundled into the CT code? AAPC Forum Subscriber Answer: You can — and certainly should — report the injection separately. On the claim, report: CPT® explicitly wants you to use these codes together. Per the notes under the descriptor for 27369: “When fluoroscopic guided injection is performed for enhanced CT arthrography, use” 27369, +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)), and 73701 or 73702 (… without contrast material, followed by contrast material(s) and further sections). This will change if the guidance is used ahead of a magnetic resonance (MR) scan. According to CPT®: “When fluoroscopic guided injection is performed for enhanced MR arthrography, use” 27369, +77002, and 73722 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)) or 73723 (… without contrast material(s), followed by contrast material(s) and further sequences). Code order matters: Since pay will be reduced by 50 percent for the second code, make sure you report 73701 on the first line of the claim. According to the Medicare Physician Fee Schedule (MPFS), 73701 has a nonfacility work relative value unit (RVU) of 1.16. On the other hand, the MPFS reports that 27369 has a nonfacility work RVU of 0.77.
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