CPT Code 73221

(2022) CPT Code 73221 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 73221 is used to code 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. 

CPT Code 73221 Description

Contrast material is not used in this technique. A 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 be used to visualize a wide variety of 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 types of articular abnormalities. However, it is only useful 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 normal radiography isn’t enough to diagnose certain articular problems accurately, and MRI can help do just that.

73221 cpt code

CPT code 73221 can be used to document MRIs that have contrast for 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.

CPT Code 73221 Billing Guidelines

MRI is a medical term for cross-sectional imaging used to evaluate a patient’s condition. In any case, a price is assigned to every CPT (current procedural terminology) code.

The carriers are reimbursing passengers. Several variables could influence the fee. The RVU is based on several factors, including the quality of the service, the likelihood of malpractice, and the revenue generated.

The overhead cost of each code is different. Using Bill Types, contractors can see which Bill Types are used most frequently to record this service. In the lack of a Bill Type, it is possible that the policy does not apply.

 Bill Type does not influence coverage because there are no Bill Types listed on the insurance. However, to differentiate between MRIs with and without a contrast agent and MRIs with and a contrast agent using CPT codes 12, 13, 18, 21, 22, and 23, as well as MRIs with and without a contrast agent, there are three categories of MRIs. 

This page includes a list of the most frequently used MRI CPT codes and guidelines for billing them. Selecting Revenue Codes can help providers identify the most widely used codes for reporting this service.

 It is important to note that most revenue codes are advisory; otherwise indicated in the policy, other revenue codes are also covered. There are no Revenue Codes in the policy, which indicates that the policy applies to all Revenue Codes.

cpt 73221

CPT Code 73221 Modifiers

Using Modifier 26 for CPT code 73221, these processes have a technical and professional component. In some cases, insurance companies may require you to use the modifiers RT and LT on two separate lines in place 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,” as explained above.

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. In the beginning, it’s best to place your order for pricing modifiers (e.g., modifier 26 and modifier TC).

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. In some cases, insurance companies may require you to use the modifiers RT and LT on two separate lines in place 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. In the event where a physician performs both the professional (supervision, interpretation, and report) and technical (equipment, supplies, and technical help) components of an operation, the global service is documented.’

 If an orthopedic surgeon obtains an X-ray of a damaged bone, this could be the case. 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, you should 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. In the beginning, it’s best to place your order for pricing modifiers (e.g., modifier 26 and modifier TC).

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.

73221 cpt code description
The modifier for CPT code 73221 is -26

CPT Code 73221 Reimbursement

To support the medical need of 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 in making 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 both the professional and technical components of the procedure. 

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 for reimbursement of the technical component. To prove your provider’s participation in the service, you must include modifier 26 on the same procedure code for the interpreting doctor.

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

Examples

The following examples are when CPT code 73221 may be used to bill services.

Example 1

A doctor orders a lab test for his patient from an outside source. As a result, the lab’s pathologist gives the attending physician with a written report. Pathologists can bill procedure 83020 with a modifier 26 to reflect the pathologist’s interpretation of the results in this situation.

Example 2

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.

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