How To Use CPT Code 23350

CPT 23350 is an injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 23350 procedures.

1. What is CPT 23350?

CPT 23350 is a medical procedure code used to describe an injection of a contrast agent into the shoulder joint for a shoulder arthrography or enhanced CT/MRI shoulder arthrography. This diagnostic test involves obtaining a series of X-ray images of the shoulder joint after the injection of the contrast agent to assess the joint for any soft tissue injury. The provider may also perform computed tomography (CT) or magnetic resonance imaging (MRI) images after the injection of contrast, which is referred to as an enhanced CT or MRI shoulder arthrography.

2. 23350 CPT code description

The official description of CPT code 23350 is: “Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography.”

3. Procedure

The 23350 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider inserts a needle into the shoulder joint cavity under the guidance of fluoroscopy.
3. A solution of contrast is injected until resistance is felt, indicating that the joint is full.
4. The provider removes the needle.
5. A separately reportable X-ray, CT, or MRI imaging of the joint is performed to assess it for injury.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 23350 services are those who have a suspected shoulder joint injury or condition that requires further diagnostic evaluation. This may include patients with shoulder pain, limited range of motion, instability, or other symptoms that suggest a possible soft tissue injury within the shoulder joint. The provider must determine that a shoulder arthrography or enhanced CT/MRI shoulder arthrography is medically necessary for the patient’s condition.

5. When to use CPT code 23350

It is appropriate to bill the 23350 CPT code when the provider performs an injection of a contrast agent into the shoulder joint for a shoulder arthrography or enhanced CT/MRI shoulder arthrography. This code should be used only for the injection of the contrast and not for the subsequent imaging procedures, which are billed separately.

6. Documentation requirements

To support a claim for CPT 23350, the provider must document the following information:

• Medical necessity for the shoulder arthrography or enhanced CT/MRI shoulder arthrography
• Details of the patient’s symptoms and clinical findings that led to the decision to perform the procedure
• Specifics of the injection procedure, including the type and amount of contrast agent used
• Any complications or adverse reactions encountered during the procedure
• Results of the subsequent imaging studies and their interpretation

7. Billing guidelines

When billing for CPT code 23350, it is important to remember that this code is only for the injection of the contrast agent and not for the subsequent imaging procedures. The imaging procedures, such as X-ray, CT, or MRI, should be billed separately using the appropriate codes. Additionally, fluoroscopy guidance (CPT 77002) is inclusive of radiographic arthrography and should not be billed separately.

8. Historical information

CPT 23350 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2002, with the previous descriptor being “Injection procedure for shoulder arthrography.”

9. Similar codes to CPT 23350

Five similar codes to CPT 23350 and how they differentiate from CPT 23350 are:

1. CPT 73040: This code is for radiographic arthrography, radiological supervision, and interpretation of the shoulder joint.
2. CPT 73201 and 73202: These codes are for enhanced CT arthrography of the shoulder joint.
3. CPT 73222 and 73223: These codes are for enhanced MRI arthrography of the shoulder joint.

10. Examples

Here are 10 detailed examples of CPT code 23350 procedures:

1. A patient with a history of shoulder dislocations undergoes a CPT 23350 procedure to evaluate the integrity of the shoulder joint’s soft tissues.
2. A patient with persistent shoulder pain and limited range of motion undergoes a CPT 23350 procedure to assess for possible rotator cuff tears.
3. A patient with a suspected labral tear undergoes a CPT 23350 procedure to confirm the diagnosis and determine the extent of the injury.
4. A patient with a history of shoulder instability undergoes a CPT 23350 procedure to evaluate the joint for possible ligamentous injuries.
5. A patient with a suspected SLAP lesion undergoes a CPT 23350 procedure to confirm the diagnosis and plan for surgical intervention.
6. A patient with a history of shoulder impingement undergoes a CPT 23350 procedure to assess the joint for possible bursal or tendon inflammation.
7. A patient with a suspected glenohumeral joint infection undergoes a CPT 23350 procedure to evaluate the joint and guide treatment decisions.
8. A patient with a history of shoulder arthritis undergoes a CPT 23350 procedure to assess the joint for possible cartilage damage or joint space narrowing.
9. A patient with a suspected shoulder joint tumor undergoes a CPT 23350 procedure to evaluate the mass and plan for further management.
10. A patient with a history of shoulder joint surgery undergoes a CPT 23350 procedure to assess the joint for possible postoperative complications or recurrent injuries.