How To Use CPT Code 73220

CPT 73220 refers to a specific magnetic resonance imaging (MRI) procedure of the upper extremity, excluding the joints, performed in two phases: first without the use of contrast material, followed by the administration of contrast material to enhance image quality. This diagnostic imaging technique is crucial for evaluating various conditions affecting the upper extremity, such as soft tissue injuries, tumors, or other abnormalities, providing detailed images that assist healthcare providers in making informed clinical decisions.

1. What is CPT code 73220?

CPT code 73220 represents a magnetic resonance imaging procedure focused on the upper extremity, specifically targeting areas other than the joints. The purpose of this imaging is to obtain high-resolution images that can reveal structural and pathological changes in the soft tissues, muscles, and bones of the upper extremity. The procedure is conducted in two stages: initially, images are captured without the use of contrast material, which allows for a baseline assessment of the area. Subsequently, contrast material is injected to enhance the visibility of certain structures, improving the diagnostic quality of the images. This dual-phase approach is particularly beneficial in identifying subtle lesions or abnormalities that may not be visible on non-contrast images alone.

2. Qualifying Circumstances

This CPT code can be utilized under specific circumstances where an MRI of the upper extremity is warranted, excluding joint evaluation. It is appropriate when a healthcare provider suspects conditions such as soft tissue injuries, tumors, or other abnormalities that require detailed imaging. However, it is important to note that this code should not be used for joint imaging or when only oral or rectal contrast is administered, as these do not meet the criteria for intravascular contrast. Additionally, if the imaging is performed solely for the purpose of evaluating joints, other specific codes should be used instead. Providers must ensure that the use of this code aligns with payer guidelines and clinical indications.

3. When To Use CPT 73220

CPT code 73220 is used when a provider performs an MRI of the upper extremity, specifically for areas other than the joints, in a two-phase approach. The first phase involves imaging without contrast, while the second phase includes the administration of contrast material to enhance the quality of the images. It is essential to document the clinical rationale for using this code, as well as the specific findings that necessitate the use of contrast. Providers should be aware that this code cannot be used in conjunction with codes that pertain to joint imaging, such as those for MRI of the joints of the upper extremity. Additionally, modifiers may be necessary depending on whether the provider is reporting the professional or technical components of the service.

4. Official Description of CPT 73220

Official Descriptor: Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences.

5. Clinical Application

The clinical application of CPT 73220 is significant in diagnosing and managing conditions affecting the upper extremity. This imaging technique provides detailed insights into the anatomy and pathology of the area, allowing for accurate diagnosis and treatment planning. The use of contrast material enhances the visibility of structures, making it easier to identify abnormalities that may not be apparent on non-contrast images. This procedure is particularly valuable in cases where a patient presents with unexplained pain, swelling, or functional limitations in the upper extremity, guiding the provider in determining the appropriate course of action.

5.1 Provider Responsibilities

During the procedure, the provider is responsible for several key actions. Initially, the provider prepares the patient for the MRI by explaining the procedure and ensuring that the patient is comfortable and understands the need to remain still during imaging. The patient is positioned on the scanning table, which is then slid into the MRI machine. The provider instructs the patient to hold their breath at specific intervals to capture clear images. After the initial imaging without contrast is completed, the provider administers the contrast material via injection. Following the injection, additional sequences of images are captured to enhance the diagnostic quality. Finally, the provider reviews the images, analyzes the findings, and prepares a comprehensive report detailing the results of the imaging study.

5.2 Unique Challenges

One of the unique challenges associated with this procedure is ensuring patient compliance during the imaging process. Patients must remain still and follow instructions, which can be difficult for some individuals, particularly those with anxiety or discomfort. Additionally, the administration of contrast material carries risks, such as allergic reactions or adverse effects, which the provider must monitor closely. The provider must also be adept at interpreting the images produced, as the quality of the results can significantly impact clinical decision-making. Furthermore, navigating payer policies regarding the use of contrast and coding can add complexity to the billing process.

5.3 Pre-Procedure Preparations

Before performing the MRI, the provider must conduct a thorough evaluation of the patient’s medical history and any contraindications to MRI or contrast material. This includes assessing for allergies, renal function, and any previous reactions to contrast agents. The provider should also ensure that the patient has removed any metallic objects that could interfere with the imaging process. Proper patient preparation is crucial to minimize risks and ensure the accuracy of the imaging results.

5.4 Post-Procedure Considerations

After the procedure, the provider must monitor the patient for any immediate adverse reactions to the contrast material. Patients are typically advised to hydrate well to help flush the contrast from their system. The provider will also review the images obtained during the MRI, analyze the findings, and prepare a detailed report that will be shared with the referring physician. Follow-up appointments may be necessary to discuss the results and determine the next steps in the patient’s care plan based on the imaging findings.

6. Relevant Terminology

Contrast: A special dye used in radiology imaging to improve the visibility of internal structures or organs of the body. It is administered through various routes, including oral and intravenously, and is essential for enhancing the quality of images obtained during procedures like MRI.

Magnetic Resonance Imaging (MRI): A non-invasive imaging technique that uses strong magnetic fields and radio waves to generate detailed images of organs and tissues within the body. It is particularly useful for visualizing soft tissues.

Upper Extremity: Refers to the upper limb of the body, including the shoulder, arm, forearm, wrist, and hand.

Intravascular Contrast: Contrast material that is injected directly into the bloodstream to enhance imaging quality during procedures like MRI.

7. Clinical Examples

1. A patient presents with persistent pain in the upper arm, prompting the provider to order an MRI to evaluate for possible soft tissue injuries.

2. Following a fall, a patient experiences swelling and bruising in the forearm, leading to an MRI to assess for fractures or hematomas.

3. A healthcare provider suspects a tumor in the upper extremity after physical examination and orders an MRI with contrast to better visualize the mass.

4. A patient with a history of repetitive strain injury in the shoulder undergoes an MRI to evaluate for tendon tears or inflammation.

5. An athlete presents with unexplained weakness in the hand, prompting an MRI to investigate potential nerve compression or injury.

6. A patient with a prior history of upper extremity surgery requires an MRI to assess for scar tissue formation or complications.

7. A provider orders an MRI for a patient experiencing numbness in the fingers, suspecting a possible vascular issue or nerve entrapment.

8. A patient with a suspected ganglion cyst in the wrist undergoes an MRI to confirm the diagnosis and assess the size and location of the cyst.

9. Following a sports injury, a patient presents with limited range of motion in the elbow, leading to an MRI to evaluate for ligament damage.

10. A patient with chronic pain in the shoulder region undergoes an MRI to rule out any underlying pathological conditions, such as bursitis or impingement syndrome.