(2023) CPT Code 73221 | Description, Reimbursement, Modifiers & Examples

CPT code 73221 reports a diagnostic technique that includes magnetic resonance imaging, or MRI imaging, of the upper extremity joints, such as the shoulder, elbow, wrist, or hand joints. 

Description Of The CPT Code 73221

Contrast material is not used in this technique. Magnetic resonance imaging (MRI) of the patient’s upper extremity joints, such as the shoulder, elbow, and wrist, is conducted in this diagnostic method. Contrast material is not used in this technique.

 Non-invasive Magnetic Resonance Imaging (MRI) can visualize various diagnoses. However, imaging several planes without being hampered by bone artifacts, visualizing blood vessels, and using safer contrast media distinguish MRI from CT. 

This imaging technique is indicated when conventional radiography fails to detect some articular abnormalities. However, it is only helpful in a small percentage of instances.

In this diagnostic technique, MRI imaging of the upper extremity joints of a patient is performed. This includes imaging of the shoulders, elbows, wrists, and hands. 

As part of the examination, an MRI scan is performed on the patient’s upper extremity joints, such as the elbow, wrist, and hand. This method does not use any contrast material. It’s recommended when routine radiography isn’t enough to diagnose some particular issues accurately, MRI can help.

The official description of the 73221 CPT code is: “Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s).”

CPT code 73221 can document MRIs that contrast the knee, ankle, midfoot, wrist, and hip. Using this CPT code, you can bill for any joint in the lower extremity.

In addition, the contrast material used in an MRI is much less toxic than that used for CT, and it may be used in multiple imaging planes without affecting bone artifacts. 

If state licensing for MRI technicians is in place, MRI technologists should be licensed in the jurisdiction in which they are employed. It is possible to perform an MRI of a joint by a doctor or a technician alone. CPT code 73221 is used for diagnostic radiology. 

For an MRI scan of the elbow joint, this code is appropriate. The costs associated with this treatment are based on publicly accessible data listing all providers that billed Medicare for this code. For this CPT code, these costs approximate what you might be charged.

Billing Guidelines & Modifiers

CPT 73221 has a technical and professional component. Insurance companies may sometimes require you to use the modifiers RT and LT on two separate lines instead of modifier 50.

When the professional component of a procedure is conducted separately, modifier 26 might be used to identify the unique service provided by the physician. However, modifier 26 can only be used for particular operations with a “professional component”.

A claim with several modifiers should be billed in the correct order before submitting the claim.MRI sections typically utilize modification 26 and modifier RT, LT, or 59. In addition, the following modifiers should be used in the following order. Initially, placing your order for pricing modifiers (e.g., modifier 26 and modifier TC) is best.

For example, modifiers 59 and 76 are informational modifiers that should be used first, whereas modifier RT and modifier LT are literality modifiers that should be used last. Again, Noridian has the instructions for the mods.

MRIs are performed and supervised by a medical professional. Therefore, these processes have a technical and professional component to them. Insurance companies may sometimes require you to use the modifiers RT and LT on two separate lines instead of modifier 50.

To properly bill a code, one must know when to bill it as a whole and when to break it down into its professional and technical components.

For example, when a facility provides the technical component of a service/operation and an individual physician performs the professional component, separate compensation may be made for the two components. 

While the physician adds modification 26 to the procedure code, the facility adds the modifier TC to the same code. When a physician performs the professional (supervision, interpretation, and report) and technical (equipment, supplies, and technical help) components of an operation, the global service is documented.’

 This could be the case if an orthopedic surgeon obtains an X-ray of a damaged bone. Modifier 26 should not be used if a different code exists to describe only a given service’s professional/physician portion. At least 12 leads are required for a routine ECG (e.g., 93010 Electrocardiogram). 

In the same way that there are codes for professional-only services on Medicare, there are codes for technical services. There is no need to utilize the “TC” modifier for an electrocardiogram (ECG) tracing if a specific code, such as 93005, exists to describe the technical component.

Before using a procedure code, verify that it can handle both modifications. As long as the Medicare Physician Fee Schedule Database (MPFSDB) field for the professional component (PC)/technical component (TC) is set to “1,” modifiers 26 and TC can be used with the procedure code.

The following modifiers should be used in the following order. Initially, placing your order for pricing modifiers (e.g., modifier 26 and modifier TC) is best.

For example, modifiers 59 and 76 are informational modifiers that should be used first, whereas modifier RT and modifier LT are literality modifiers that should be used last. Noridian has the instructions for the mods.

Reimbursement

To support the medical need for a cervical spine MRI, strictly adhere to the state LCD standards, which a specific vendor supplies.

There are many reasons for missed payments in radiology practices: incorrect modifier usage, defined as either the incorrect modifier being added to a claim or no modifier being used when appropriate. 

When studying the pathology report, a treating physician cannot claim services rendered because the pathologist has already interpreted the test, demonstrating improper usage. She can apply her interpretation to medical judgments, but she should not bill for it.

It’s important to note that modifiers might be applied to codes based on where a radiological service is performed, who owns the equipment, and who provides the interpretation.

As a global CPT code, 71020 (two views of the chest, frontal and lateral) incorporates the procedure’s professional and technical components. 

The entire cost of the package was considered when calculating the relative value units. Therefore, a modifier must be added to the code on the CMS-1500 form to indicate that the service provider is owed a reduction in reimbursement while only billing for a portion of the service.

The testing facility must also submit a claim to reimburse the technical component. To prove your provider’s participation in the service, you must include modifier 26 on the exact procedure code for the interpreting doctor.

Thus, reporting the 26 modifiers correctly reduces the risk of incorrect payer denials and delays in payment.

Billing Example

Early labor has led to an emergency hospital visit by a pregnant lady. In the hospital, an ultrasound determines if there are any complications with the pregnancy.

Medical records and imaging results are forwarded with the patient to a specialist for additional evaluation. Modifier 26 on the ultrasound CPT would denote the specialist’s interpretation-only service as they evaluate and interpret the ER ultrasound for the patient.

In this case, the billing would be CPT 73221 with modifier 26.