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From: The Rheumatologist, June 2009

Coding MRI Procedures

The Current Procedural Terminology (CPT) manual has six codes to bill for Magnetic Resonance Imaging (MRI) of the upper extremity:

  • 73218 - Magnetic resonance (e.g., proton) imaging, upper extremity, other than joint; without contrast material(s);
  • 73219 - MRI, upper extremity, other than joint; with contrast material(s);
  • 73220 - MRI, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences;
  • 73221 - Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; without contrast materials;
  • 73222 - MRI, any joint of upper extremity; with contrast material(s); and
  • 73223 - MRI, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences.

The use of CPT code 73218 has recently been linked to reporting issues in physician practices, and physicians using MRI machines in their offices—or ordering MRIs from a diagnostic center—should be careful that they are choosing the correct procedural code.

Early identification of patients who will develop more severe, disabling diseases allows physicians to provide the best treatments available. Patients suffering from rheumatoid arthritis (RA) occasionally need further testing for early detection and treatment.

The detection of bone erosions is a specific finding in RA and serves an important role in therapeutic planning. For many years, an X-ray has been the standard test available to detect erosions in patients with aggressive disease. More recently, MRI has been shown to be highly sensitive for the detection of early erosions, because it is able to detect erosions earlier than an X-ray in RA patients.1 Utilizing different pulse sequences allows MRI to characterize the erosions and allows the physician to evaluate and manage treatment early in the course of the disease.

The case below describes MRI imaging of the musculoskeletal system for a patient with RA. Do you know the correct way to code for this visit? The answer on p. 22 will give the appropriate CPT choices and information on the correct and incorrect usage of codes for these procedures.

Note: Just as each patient is unique, so is the coding. The information in this case study pertains to this case only. Other similar cases might be applicable to situations that are comparable to what is happening in physician practices. Cases vary, so remember to review all available information carefully before choosing the appropriate CPT code(s) for your specific case.


  1. McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis. 1998;57:350-356.


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