Coding for shoulder arthrogram, injection of contrast, and use of CT or MR guidance

Q.

Can you tell me the difference between CPT^® codes 73040 and 23350?

A.

CPT code 73040 is the imaging (and interpretation) of a shoulder arthrogram – the old-fashioned X-ray and fluoroscopic arthrogram imaging of the shoulder joint that was done before CTs and MRIs were an option. It is still done occasionally. But most of the time CPT code 73040 is assigned, it is being coded incorrectly. One or two images to make sure the needle/contrast is in the right location is not an arthrogram. If contrast is injected and the patient is then taken for a CT or MRI without a full radiographic/fluoroscopic arthrogram, then CPT code 73040 should not be submitted. 

CPT code 23350 defines the injection of contrast into the shoulder joint for either a radiographic and fluoroscopic arthrogram (CPT 73040), a CT arthrogram (CPT 73201), or MR arthrogram (CPT 73222). 

If an injection is done prior to a CT or MR arthrogram and fluoro guidance is used for guiding the injection, then you can report CPT code 77002 as well as CPT code 23350. 

The codes and full descriptions are as follows:

73040 Radiologic examination, shoulder, arthrography, radiological supervision and Interpretation

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

77002 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)

73201 Computed tomography, upper extremity; with contrast material(s)

73222 Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; with contrast material(s)