Can you provide any coding and documentation guidelines for billing a shoulder joint arthrogram (23350) that is performed at the same time as a shoulder MRI with contrast vs. shoulder joint injection of contrast for MRI (20610)?
Injection of contrast into a joint for magnetic resonance imaging (MRI) without a diagnostic radiographic arthrogram should not be reported with code 20610. Instead, assign the appropriate arthrogram injection code such as 23350. If fluoroscopy is used to guide the injection, add code 77002.This includes an image or two to check needle placement or contrast injection.
If a true diagnostic radiographic arthrogram is ordered and performed prior to the MRI, then the arthrogram injection code and supervision and interpretation (S & I) code would be assigned and fluoroscopic guidance would be included. Do not report 77002 in addition to the arthrogram S & I code. In both cases, the MRI would be a “with contrast” exam.
For instance, a shoulder MRI with intra-articular injection of contrast would be coded 23350, 77002, 73222; a shoulder arthrogram with subsequent MRI would be 23350, 73040, and 73222.
Documentation should be clear as to whether a true radiographic arthrogram was performed to allow coding of 73040 or other S & I code or whether an arthrogram injection was performed under fluoro guidance prior to MRI.