How to Code Arthrographies For Increased Pay Up
Published on Tue Aug 01, 2000
Many radiology coders may wonder how to report magnetic resonance imaging (MRI) of the shoulder, as opposed to magnetic resonance arthrography. In addition, others wonder how to code MR arthrography as opposed to conventional arthrography.
Differences Between MRI and MR Arthrography
MRIs and MR arthrographies have their similarities but are considerably different studies, explains Ellen Ratnofsky, RN, BSN, CS, of Healthcare Administrative Partners Inc., which provides medical billing and practice management services in seven states. An MRI is a more generalized procedure providing images of soft tissue, while MR arthrography supplies greater detail of the bony areas directly at the shoulder joint. MR arthrography actually includes an MRI.
She also notes that a radiology technologist may perform an MRI, but MR arthrography requires the expertise of a radiologist.
A standard MRI with contrast is reported using CPT 73221 (magnetic resonance [e.g., proton] imaging, any joint of upper extremity), she says. During an MRI with contrast, the medium is injected intravenously and images are taken of how it progresses through the limb.
MR arthrography of the shoulder, however, includes an intra-articular injection of contrast, usually gadolinium. In other words, the agent is delivered directly into the cavity of the joint. The injection often is aided by fluoroscopic guidance to ensure that the needle is positioned correctly. This is then followed by an MRI study.
The MR arthrogram would be assigned codes CPT 23350 (injection procedure for shoulder arthrography) for the shoulder injection, followed by the MRI code 73221. Although fluoroscopic guidance is used during the injection procedure, it would not be coded separately. According to the Correct Coding Initiative (CCI), the fluoroscopy would be bundled into 23350.
Diagnosing Specific Conditions
MRIs of the shoulder most often are done when a patient is experiencing joint pain, 719.41 (pain in joint, shoulder region), and the physician is trying to diagnose a specific problem in the soft tissue, like a tear in the rotator cuff, 840.4 (sprains and strains of shoulder and upper arm; rotator cuff [capsule]), explains Brian Effron, CHMBE, president of Healthcare Administrative Partners, which has offices in Media, Pa.; Newton, Mass.; and Portsmouth, N.H. Magnetic resonance arthrography, on the other hand, is performed when more serious pathology is suspected.
Ratnofsky adds that these may include osteomyelitis, 730.01 (acute osteomyelitis of the shoulder region), circulatory disorders like an embolism or thrombosis, 444.21 (arterial embolism and thrombosis; of arteries of the extremities; upper extremity), or cancer (e.g., 195.4, malignant neoplasm of other and ill-defined sites; upper limb; or 170.4, malignant neoplasm of bone and articular cartilage; scapula and long bones of upper limb).
MR Arthrography Considered Investigational
Some clinicians cite advantages for an MR arthrogram over the more traditional MRI. There is [...]
