Radiology Coding Alert

TMJ and wrist arthrography are exceptions for S&I inclusions.

Are you confused over arthrography coding options? You can ease your coding if you adopt some basic principles. The first step is to confirm in which joint your physician performed the arthrography. The challenge then lies in determining if you can report the supervision and interpretation of your radiologist. Here is what experts advise to improve your coding for arthrography.

Check Joint for Arthrography 

When reporting arthrographic procedures, the first step to the right code is to check which joint your physician assessed. “A complete arthrography includes an injection into a joint, multiple images of the joint, followed by formal interpretation of those images,” says Christy Hembree, CPC, team leader at Summit Radiology Services in Cartersville, GA.

For arthrography in the shoulder, elbow, and wrist, you submit codes 73040 (Radiologic examination, shoulder, arthrography, radiological supervision and interpretation), 73085 (Radiologic examination, elbow, arthrography, radiological supervision and interpretation), and 73115 (Radiologic examination, wrist, arthrography, radiological supervision and interpretation), respectively.

Similarly, for joints in the lower limb, you have specific codes for the hip, knee, and ankle arthrography. These codes are listed below:

• 73525, Radiologic examination, hip, arthrography, radiological supervision and interpretation
  
• 73580, Radiologic examination, knee, arthrography, radiological supervision and interpretation
  
• 73615, Radiologic examination, ankle, arthrography, radiological supervision and interpretation.
  

Make note: All these arthrography codes are inclusive of radiological supervision and interpretation. When your physician does a full and complete radiographic and fluoroscopic arthrography, you do not report code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with codes 70332, 73040, 73085, 73115, 73525, 73580, or 73615. “Conventional radiographic arthrography is reported with radiological supervision and interpretation (RS&I) imaging codes from the 70000 series of CPT® codes,” Hembree says. “Fluoro is included in RS&I codes so do not report it separately.” 

Look at Different Codes for Injection Procedures

You have a series of codes for injection procedures in arthrography of various joints.  

To report injections for arthrography in the joints of upper limb, you select from the following codes:

• 25246, Injection procedure for wrist arthrography 
  
• 24220, Injection procedure for elbow arthrography
  
• 23350, Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography.
  

When reporting radiographic arthrography in the shoulder, you submit code 73040 for radiological S&I. Note that fluoroscopy (77002) is inclusive of radiographic arthrography. When your physician does fluoroscopic guided injection for enhanced CT arthrography in the shoulder, you report codes 23350, 77002, and 73201 or 73202. If your physician uses fluoroscopic guidance to inject a joint for intra-articular contrast enhanced CT arthrography and performs no conventional radiographic arthrography procedure, it is then appropriate to report the fluoroscopic guidance code (CPT® 77002) instead of a RS&I code,” Hembree says.

Similarly, when your physician does fluoroscopic guided injection for enhanced MR arthrography in the shoulder, use 23350, 77002, and 73222 or 73223. For enhanced CT or enhanced MRI arthrography, you submit codes 77002 and either 73201, 73202, 73222, or 73223.

For S&I in the elbow and wrist arthrography, submit codes 73085 and 73115, respectively.

For injections in the hip, knee, and ankle for arthrography in these joints, you submit codes 27093 (Injection procedure for hip arthrography; without anesthesia), 27370 (Injection procedure for knee arthrography), and 27648 (Injection procedure for ankle arthrography), respectively. 

You will also need to submit appropriate codes for S&I. For radiological S&I, you report code 73525, 73580, and 73615 for hip, knee, and ankle arthrography, respectively. Remember, you do not report 77002 in conjunction with 73525, 73580, and 73615.

Summary: When your physician uses fluoroscopy to assess the joint to inject contrast for CT or MRI arthrography, you report fluoroscopic guidance (77002) as well as the joint-specific code for injection procedure. In addition, you report the CT or MRI codes for with/without followed by with contrast. “Fluoroscopy guidance CPT® code 77002 should be used in conjunction with the arthrography procedure codes only when formal arthrography is not performed,” Hembree says.

Tip: You do not report the S&I code for arthrography with CT or MRI unless your physician does a complete and actual diagnostic radiographic arthrography in addition to the CT or MRI. If your physician does not perform the definitive diagnostic arthrography, you submit code 77002 instead of the site-specific S&I codes for arthrography. 

TMJ Has Dedicated Codes

For arthrography in the temporomandibular joint, you report code 70332 (Temporomandibular joint arthrography, radiological supervision and interpretation). For injection procedure for temporomadibular arthrography, you turn to code 21116 (Injection procedure for temporomandibular joint arthrography).

Supervision and interpretation: You have a one-to-one correlation for S&I and procedure codes for arthrography. You do not report an independent fluoroscopy code when billing for the site-specific S&I code for arthrography. 

Exceptions: Important exceptions to this rule are the TMJ and wrist joint arthrography procedures.

Find When You Report G0259 and G0260

When your physician administers injections for sacroiliac joint arthrography, you report code 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed). This code includes imaging guidance, i.e. fluoroscopy and/or CT used by your physician to confirm the intra-articular needle positioning. However, if your physician administers a sacroiliac joint injection without imaging guidance, you do not submit code 27096. You instead report code 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]). 

“As instructed by the notes in the CPT® book, you use procedure code 27096 only with CT or fluoroscopy imaging confirmation of intra-articular needle positioning,” Hembree says. “The notes state that if CT or fluoroscopy imaging is not performed you should use 20552.”

Note: You do not submit code 27096 to Medicare for outpatient billing.

For sacroiliac joint arthrography on hospital Medicare patients, you report level II HCPCS code G0259 (Injection procedure for sacroiliac joint; arthrography). The code G0260 (Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography) is another alternative. This code is inclusive of arthrography, when performed. Physician practices can report G0259 but not G0260. “HCPCS code G0260 (sacroiliac joint injection of anesthetic agents or steroids) was added to the list of approved Ambulatory Surgical Center procedures for services performed on or after July 1, 2003 (CMS-1885-FC, 3/28/03),” Hembree says. “Therefore, when a therapeutic sacroiliac joint injection is administered to a Medicare beneficiary at an Ambulatory Surgical Center, you should report it with HCPCS code G0260.”

Also: Code 27096 is a unilateral procedure. For a bilateral procedure, use modifier 50 (Bilateral procedure).