Radiology Coding Alert

Question: What are the differences among TMJ codes 70328, 70330 and 70332?

Rhode Island Subscriber

Answer: Codes 70328 (Radiologic examination, temporomandibular joint, open and closed mouth; unilateral) and 70330 (... bilateral) both describe x-rays of the temporomandibular joint (TMJ).

If the documentation indicates a TMJ x-ray in two projections of one side, one film with the mouth open and one with the mouth closed, you should report 70328 (unilateral). Report bilateral code 70330 if the documentation shows this TMJ exam on both sides.

Note: Having separate codes for unilateral and bilateral TMJ x-rays distinguishes these services from 70336 (Magnetic resonance [e.g., proton] imaging, temporomandibular joint[s]). The term "joint[s]" in the MRI descriptor indicates that you should use this code for unilateral or bilateral services.

The radiologist must provide general supervision for Medicare patients, meaning the physician must provide direction and control during the procedure.

Arthrography: For 70332 (Temporomandibular joint arthrography, radiological supervision and interpretation), the radiologist must provide personal supervision for Medicare patients, meaning the physician must be in attendance in the room during the procedure.

Arthrography is a radiographic contrast joint study. The provider injects contrast into the joint, and then takes x-rays in multiple projections. The contrast allows the radiologist to see more details than a conventional x-ray.

Tip: You may report the contrast injection separately with 21116 (Injection procedure for temporomandibular joint arthrography).

You should report 70332 and 21116 twice if the radiologist performs the procedure on both the right and left sides.

ICD-9: A physician may order TMJ x-ray services for diagnoses including the following:

• TMJ pain (524.62, Arthralgia of temporomandibular joint)

• TMJ syndrome (524.60, Temporomandibular joint disorders, unspecified)

• TMJ disc disease (524.63, Temporomandibular joint disorders; articular disc disorder [reducing or nonreducing])

• abnormal sounds, such as clicking noises when opening and closing the jaw (524.64, Temporomandibular joint sounds on opening and/or closing the jaw).

-- The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.