Radiology Coding Alert

Question: My physician is not satisfied with billing only fluoroscopy when he does an injection of contrast into the shoulder accompanied by spot films and an MRI evaluation. He was questioning if we should charge a shoulder arthrogram instead of just fluoroscopy, because he also administered an injection and took spot films. Here is an excerpt from his dictation: "Under fluoro-scopic guidance, a 22-gauge spinal needle was placed into the shoulder joint. 16 cc of a 3-to-1 solution of 1% Magnevist diluted in normal saline and Conray 60 were injected. Two spot radiographs were obtained. The patient then underwent an MRI." California Subscriber Answer: The injection code should be 23350 (Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography), whether the contrast is used for an arthrogram, a CT, an MRI, or some combination of these. If he uses only fluoroscopy (with or without confirmatory films to document the intra-articular location of the contrast), then you can code only 76003 (Fluoroscopic guidance for needle placement) for the guidance of the contrast injection.

However, if a complete arthrogram is also obtained through overhead, spot, or digital filming, then you should use 73040 (Radiologic examination, shoulder, arthro-graphy, radiological supervision and interpretation) as the RS&I code instead of, but not in addition to, 76003. And, you should code the cross-sectional imaging technique (CT or MRI). In your case, it looks as though you cannot bill an arthrogram because two spot films were taken. The spot films appear to be related to the fluoroscopic needle placement.