What is 73130 CPT code description and guidelines 2023

What is 73130 CPT code description and guidelines 2023

According to AMA, the CPT code 73130 refers to medical procedures for the diagnostic radiology (Diagnostic Imaging) procedures of the upper extremities.

According to AMA, the CPT code 73130 refers to medical procedures for the diagnostic radiology (Diagnostic Imaging) procedures of the upper extremities.

Here are some typical upper extremity diagnostic radiology procedures for 73130.

What is CPT code 73130 described as?

CPT code 73130 describes a diagnostic radiology procedure known as “Magnetic Resonance (Eg, Proton) Imaging, Upper Extremity, Other Than Joint; Without Contrast.”

It represents an MRI of the upper extremity (e.g., arms, shoulders) without using contrast agents to assess soft tissues and structures for various medical conditions.

Also read: 99211 CPT code description, modifiers and guidelines

Can 73130 CPT code be used for both diagnostic and therapeutic purposes?

No, It is only used for diagnostic purposes. It is primarily employed to obtain detailed images to diagnose conditions affecting the arms, shoulders, and related structures.

Suppose an MRI is performed with a therapeutic intent, such as guidance for a minimally invasive procedure or monitoring the effects of a therapeutic intervention.

In that case, you may use a different CPT code.

Type of imaging technology is typically used for CPT code 73130

Magnetic resonance imaging (MRI) is most frequently employed for CPT code 73130.

MRI Usage

  • Upper Extremity Imaging:

CPT code 73130 describes MRI scans of the upper extremities, including the arms and shoulders.

  • Diagnostic Purpose:

This code is mostly used for diagnostic imaging, showing upper limb soft tissues, muscles, tendons, ligaments, and other structures.

  • Without Contrast:

It specifies that the MRI procedure does not involve administering contrast agents. This code is for MRI scans conducted without contrast enhancement.

Does insurance cover CPT Code 73130?

73130 is covered by insurance depending on several factors, including the specific insurance plan, the medical necessity of the procedure, referral, deductibles and co-payments, preauthorization, and the patient’s circumstances.

Special preparations required for patients undergoing a radiologic examination with CPT code 73130:

  • Patients should wear comfortable clothing without any metal objects.
  • Remove all jewelry, watches, and metal objects before the procedure.
  • Inform the healthcare provider if the patient has any medical implants or devices that might be affected by the MRI.
  • Patients may be encouraged to hydrate or avoid specific foods and drinks before the MRI.
  • Patients should disclose allergies, medical problems, and medications to their doctors.

Please note that specific preparation requirements may vary depending on the patient’s condition and the imaging facility’s policies.

Some of the 73130 exemptions

An MRI of the upper extremities, CPT code 73130, may not be performed if:

  • Presence of incompatible medical implants or equipment in the area of interest, such as certain pacemakers or metallic foreign bodies.
  • Severe claustrophobia or anxiety could make it difficult for the patient to stay still throughout the surgery.
  • Allergies to the contrast material used during the MRI, if necessary for the test.
  • Pregnancy in the first trimester can change depending on the clinical situation and risk assessment.
  • The inability to lie still for a long time is necessary for the MRI to provide clear images.

Risks associated with CPT Code 73130

  1. Allergic Reactions
  2. Claustrophobia
  3. Metallic Objects
  4. Pregnancy Considerations
  5. Incompatibility with Medical devices
  6. Noise Exposure

The benefits of getting diagnostic information, however, outweigh these potential risks, and overall, the risks connected to CPT Code 73130 are typically less.

Does CPT 73130 need a modifier?

This Cpt code doesn’t usually need a modifier unless any of the following situations occurs.

  • Distinct Procedures

In the case that the hand x-rays are done at the same time as another treatment on the same hand, you might need to add a modifier to show that the procedures are separate and not combined.

  • Bilateral Imaging

You can use the LT/RT modifiers to show which side of the process is being done if wrist x-rays are taken on both hands at the same time.

For instance: (Use code 73130 LT for an x-ray of the left hand and 73130 RT for an x-ray of the right hand.)

Other Modifiers for 73130

Have a look at the modifiers that might be considered in very rare situations/ cases.

  1. Modifier 26: It’s used when the technical part, which includes how the X-ray actually worked, is given separately from the analysis and report of the X-ray.
  2. Modifier 52: This modifier can be used if only a few images from the wrist X-ray set are captured for the record.
  1. Modifier 59: When more than one procedure is done at the same time and isn’t usually recorded together, this modifier may take place. (rare scenario)
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