CPT code 73223 is for an MRI of an upper extremity joint, performed both without and with contrast dye, to provide detailed imaging for diagnosis.
CPT code 73223 is used to describe an MRI (Magnetic Resonance Imaging) procedure of a joint in the upper extremity, such as the shoulder, elbow, or wrist. This specific code indicates that the MRI is performed both without and with contrast dye. The use of contrast dye helps to enhance the images, providing more detailed information about the joint's structures, which can be crucial for diagnosing conditions like tears, inflammation, or other abnormalities.
When dealing with CPT codes 73222 and 73223 for MRI of the upper extremity joint with and without contrast, the use of modifiers may be necessary to provide additional information about the procedure performed. Here is a list of potential modifiers that could be used:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the MRI results, not the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of the equipment and the performance of the MRI, excluding the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the MRI is performed in conjunction with another procedure that is not typically performed together. It indicates that the procedures are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the same physician performs a repeat MRI on the same day. It indicates that the procedure was repeated for a valid reason.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a repeat MRI is performed on the same day by a different physician. It signifies that the procedure was necessary and performed by another provider.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can be relevant if the MRI is repeated for clinical reasons, such as monitoring the progression of a condition.
7. Modifier 52 (Reduced Services): This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the full service was not performed.
8. Modifier 53 (Discontinued Procedure): This modifier is applicable if the MRI procedure is started but discontinued due to extenuating circumstances or patient safety concerns.
These modifiers help clarify the specifics of the service provided and ensure accurate billing and reimbursement. It's important to apply the appropriate modifier based on the specific circumstances of the MRI procedure.
The CPT code 73223 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS).
Whether or not this code is reimbursed by Medicare can depend on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region.
Each MAC may have different coverage determinations and reimbursement rates based on local medical necessity and other criteria.
Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC's guidelines to determine the reimbursement status and any specific requirements for CPT code 73223.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 73223, RevFind provides unparalleled insights by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and maximize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
