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Basics of Arthrogram CPT code of Hip, Shoulder, Wrist, ankle & elbow

An arthrogram is a test using X-rays to obtain a series of images of a joint after a contrast material like dye, water, air or a combination of these has been injected into the joint. This exam helps the physician to detect any abnormality in the soft tissues of joints such as tendons, ligaments, muscles, cartilage and your joint capsule. A special type of X-ray called fluoroscopy is used to take pictures of the joint.

In medical coding, we have separate CPT codes for each joint for arthrogram injection. We have already learnt about coding joint procedures like arthrocentesis, MRI, CT CPT codes for joints which are mainly done to find any diagnosis related to joints. You can get more information on diagnostic radiology in below topics.

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Myelogram

Arthrocentesis

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Rules for CPT codes for AV Fistula Coding

Coding tips for Sentinal Node Injection

Coding guide for CPT codes for Moderate Conscious Sedation

Fine Needle Aspiration

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Let us see how we can code hip, knee, ankle, shoulder, elbow, wrist or jaw (temporomandibular joint) arthrography procedures in diagnostic radiology facility coding.

Other tests, such as magnetic resonance imaging (MRI) and computed tomography (CT), give different information about a joint. They may be used with an arthrogram or when an arthrogram does not give a clear picture of the joint.

CPT code for Shoulder arthrogram injection

We have direct procedure codes for coding arthrogram exam for each joint. We should remember to code fluoroscopy or radiology supervision and interpretation CPT codes along with arthrogram codes. Below are the CPT code for shoulder arthrography.

23350 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography

This procedure is commonly used in the diagnosis of a rotator cuff tear. The patient is positioned supine on the x-ray table. The skin and deep tissues lateral to the coracoid process are injected with a local anesthetic. A no. 20 spinal needle 7.5 cm long is inserted into the joint at the same location and the position is checked by separately reportable x-ray. From 15 ml to 20 ml of a suitable contrast medium is injected; resistance is felt when the joint is full. The shoulder is taken through a full range of motion and separately reportable x-rays are taken to see if there is leakage of the substance to other parts of the joint and a proper diagnosis is made.

For radiological supervision and interpretation (S&I), use CPT code 73040.

The synovial joint of the shoulder is visualized internally through arthrography, the direct injection of air and/or contrast material into the joint for radiological examination. Local anesthesia in injected into the joint followed by the contrast material and/or air. A series of images are taken and interpreted. Fluoroscopic films and guidance for needle localization is included. Arthrography helps diagnose conditions of cartilage abnormalities, arthritis and bursitis, rotator cuff tear, and frozen joint. AP (front to back) views are taken with the affected arm rotated externally and internally and with the arm in a neutral, flexed position lying over the abdomen.

Fluoroscopy (CPT code 77002) is included in radiographic arthrography (S&I)

But when only fluoroscopic guided injection is performed for enhanced CT arthrography, use code 23350 with 77002. And for CT arthrography of shoulder we have to use CPT code 73201 and 73202.

Always remember, CT or MRI of Joint followed by Arthrogram or Myelogram should be always coded with Contrast CPT codes.

For fluoroscopic guided injection for MR or MRI arthrography of shoulder, we have to use CPT code 23350, 77002, and 73222 or 73223.

Do not use CPT code 73040 and 77002 together, since fluoroscopy is included in supervision and interpretation.

CPT code for Knee arthrogram

We have similar coding guidelines for knee arthrography. Here we have separate CPT codes for CT or MRI enhanced arthrography for lower extremity. Below are the CPT code for knee arthrogram.

27370 (deleted in 2019) Injection of contrast for knee arthrography

CPT 27369 was added in 2019 to report an injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography.

The physician injects contrast for knee arthrography or contrast enhanced CT/MRI knee arthrography. Arthrography is radiological imaging for evaluation of joints. Typical arthrography involves the use of fluoroscopy as well as contrast containing iodine. In arthrography, utilizing magnetic resonance imaging (MRI), a different type of contrast material containing gadolinium, a material that affects the local magnetic field of the MRI, is injected into the joint outlining the structures within the joint. For CT arthrography, the contrast material is the same as that used for standard arthrography. The patient is placed supine (lying on the back) on an x-ray table with the knee flexed over a small pillow. A skin anesthetic may be applied. The physician passes a 20-gauge needle into the femoropatellar space. Air and/or a single or double contrast agent are injected into the space in preparation for the procedure. After the injection is complete, the patient is asked to move the knee to ensure adequate distribution of the contrast material in the joint structures. Multiple roentgenographic views are taken of the knee.

CPT code 27370 was deleted likely due to being reported incorrectly as arthrocentesis or aspiration.

For radiological supervision and interpretation, use CPT code 73580.

Do not report 77002 along with 73580, it is included in supervision and interpretation.

For coding fluoroscopic guided injection for CT or MRI enhanced arthrography of knee we have use code 27370, 77002 and 73701, 73702 (for CT), 73722, 73723 (for MRI).

For coding arthrocentesis procedures, we have separate CPT codes. Use Procedure code 20610 and 20611 for coding knee injection for arthrocentesis exam.

CPT code for Hip arthrogram

We have two separate CPT code for Hip arthrogram for with and without anesthesia. Only for General Anesthesia (not Local Anesthesia) we have to use CPT code 27095. Below are CPT codes for Hip arthrography injection procedures.

27093 Injection procedure for hip arthrography; without anesthesia

27095 with anesthesia

The physician may apply skin traction to increase the space between the femoral head and acetabulum. Using a fluoroscope, the physician places a metallic marker over the femoral neck. The point is marked on the skin with ink. The femoral artery is palpated and marked on the skin as well, avoiding inadvertent puncture. The physician inserts a needle (1 1/2″ for children, 3 1/2″ for adults) and passes it into the capsule (located by fluoroscope). The synovial fluid is aspirated for a culture check. After aspiration, a contrast agent is injected into the hip joint and the needle is removed. X-rays are taken with the hip in neutral, external, and internal rotation for children and adults. The frog leg position is also taken for children. A second set of x-rays may be taken following the hip movements. For CPT code 27093 the procedure is performed without anesthesia and with anesthesia for CPT code 27095.

For radiological supervision and interpretation, use CPT code 73525.

Do not report 77002 in conjunction with 73525.

For CT enhanced fluoroscopic injection for hip arthrography we have use below codes.

27093, 77002 and 73701,73702 (CT Lower extremity)

For MR or MRI enhanced for fluoroscopic injection for hip arthrography we have use below codes.

27093, 77002 and 73722,73723 (MRI Lower extremity joint)

CPT code for Elbow Arthrogram

24220 Injection procedure for elbow arthrography

For radiological supervision and interpretation, use CPT code 73085.

Do not report 77002 in conjunction with 73085

CPT code for Wrist arthrogram

25246 Injection procedure for wrist arthrography

The physician injects contrast material into the wrist joint for arthrography. The physician inserts a needle into the wrist and aspirates joint fluid for culture. Contrast material is injected into the wrist and the wrist is manipulated to distribute the dye. As the dye fades, a second injection may be made.

For radiological supervision and interpretation, use CPT code 73115.

The wrist is visualized internally through arthrography, the direct injection of air and/or contrast material into the joint for radiological examination. Local anesthesia in injected into the joint followed by the contrast material and/or air. A series of images are taken and interpreted. Fluoroscopic films and guidance for needle localization is included. Arthrography helps diagnose conditions of cartilage abnormalities, arthritis and bursitis, and frozen joint. The hand and wrist is placed in the posteroanterior (PA) position with the hand rotated outward and the x-ray beam aimed vertically at the wrist or with the hand and wrist in PA position with the beam aimed at the wrist from a few degrees below the elbow.

Do not report 77002 in conjunction with 73115

CPT code for Ankle arthrogram

27648 Injection procedure for ankle arthrography

The physician injects radiopaque fluid into the ankle for arthrography. The physician inserts a needle into the ankle joint and aspirates if necessary. Opaque contrast solution is injected into the ankle, and the needle is removed. A separately reportable arthrogram is taken of the ankle.

For radiological supervision and interpretation, use CPT code 73615.

The physician injects radiopaque fluid into the ankle for arthrography. The physician inserts a needle into the joint and aspirates if necessary. Opaque contrast solution is injected into the ankle and the needle is removed. Films are taken of the ankle. This code reports the radiological supervision and interpretation only. Use a separately reportable code for the injection.

Do not report 77002 in conjunction with 73615.