73221

Magnetic resonance (MR) imaging, upper extremity; without contrast material(s)

Magnetic Resonance Imaging (MRI) of a single upper extremity (e.g., shoulder, humerus, elbow, forearm, wrist, hand) performed without the administration of intravenous contrast material. This diagnostic imaging technique utilizes a powerful magnetic field and radio waves to generate detailed cross-sectional images of bones, soft tissues (muscles, tendons, ligaments, cartilage), blood vessels, and nerves, providing high-resolution anatomical information without using ionizing radiation. This code applies when only non-contrast sequences are obtained.

Clinical Indications

  • Evaluation of rotator cuff pathology (e.g., tears, tendinopathy, impingement syndrome)
  • Assessment of labral tears or instability in the shoulder
  • Diagnosis of avascular necrosis (osteonecrosis)
  • Evaluation of ligamentous or meniscal injuries (e.g., elbow collateral ligament tears, triangular fibrocartilage complex tears in the wrist)
  • Assessment of unexplained pain, swelling, or limited range of motion in the upper extremity
  • Detection and characterization of bone tumors, soft tissue masses, or cysts
  • Diagnosis of osteomyelitis or other infections of bone and soft tissue
  • Evaluation of stress fractures or occult fractures not seen on plain radiographs
  • Assessment of nerve entrapment syndromes (e.g., carpal tunnel syndrome, cubital tunnel syndrome)
  • Pre-operative planning for orthopedic surgery of the upper extremity
  • Post-operative evaluation for complications or persistent symptoms (note: metal artifacts may be an issue)

Procedure Steps

  1. Patient screening for contraindications to MRI (e.g., pacemakers, certain metallic implants, claustrophobia).
  2. Patient positioning on the MRI scanner table, often with the upper extremity placed in a specialized coil.
  3. Immobilization of the extremity to minimize motion artifact during image acquisition.
  4. Initiation of the MRI sequence protocol designed for the specific anatomical region of interest (e.g., shoulder, elbow, wrist).
  5. Acquisition of multiple imaging sequences (e.g., T1-weighted, T2-weighted, STIR, proton density) in various planes (axial, sagittal, coronal) to optimally visualize different tissue characteristics.
  6. Monitoring of the patient throughout the scan by a technologist.
  7. Post-processing of acquired images for review and interpretation by a radiologist.

Coding Guidelines

  • CPT code 73221 describes MRI of a single upper extremity without contrast. For bilateral upper extremity MRI without contrast, it is appropriate to report 73221 with modifier 50 or on two separate lines with modifiers RT and LT, depending on payer guidelines.
  • If contrast material is administered, even for a limited portion of the study, report CPT code 73222 (with contrast) or 73223 (without contrast, followed by with contrast and further sequences).
  • An upper extremity includes the shoulder, humerus, elbow, forearm, wrist, and hand. This code is generally applied to one of these major joint/bone areas.
  • Documentation must clearly specify the anatomical region imaged (e.g., left shoulder, right wrist) and confirm that no contrast was administered.
  • Supervision and Interpretation (S&I) are inherent in this code; separate reporting for S&I is not typically permitted for hospital outpatient or independent diagnostic testing facility (IDTF) settings.
  • Review payer-specific policies regarding medical necessity and appropriate use criteria for MRI of the upper extremity.

Associated ICD-10 Codes