Pain Management Coding Alert

Question: Notes indicate that the PM physician performed a knee X-ray along with an ankle X-ray. I’m not sure about the coding, because I see that some of the X-ray codes include arthrography. What is arthrography, and how should I code this encounter?

Kentucky Subscriber

Answer: When reporting X-rays that may or may not include arthrography, things can get complicated. For the knee X-ray, you’ll choose from the following codes, depending on encounter specifics:

• 73560 — Radiologic examination, knee; 1 or 2 views
• 73562 — … 3 views
• 73564 — … complete, 4 or more views
• 73565 — … both knees, standing, anteroposterior
• 73580 — Radiologic examination, knee, arthrography, radiological supervision and interpretation.  

For the ankle X-ray, you’ll choose from the following codes, depending on encounter specifics:

• 73600 — Radiologic examination, ankle; 2 views
• 73610 — … complete, minimum of 3 views
• 73615 — Radiologic examination, ankle, arthrography, radiological supervision and interpretation.

Definition: According to Johns Hopkins Medicine, arthrography is a “type of imaging test used to look at a joint, such as the shoulder, knee, or hip. It may be done if standard X-rays do not show the needed details of the joint structure and function.”

During an arthrography, “a long, thin needle is used to put contrast dye right into the joint and a series of X-rays is taken with the joint in various positions. X-rays use small amounts of radiation to get pictures of the inside of the body. Sometimes air is used as the contrast substance when regular contrast cannot be used.”

Best bet: Go back and check the number of views for the knee and ankle X-rays, and then check if either involved an arthrography. Then, you should be able to choose the appropriate X-ray codes.  

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