CPT Code 23350: Under Introduction or Removal Procedures on the Shoulder

Learn about CPT code 23350 for shoulder joint contrast injections, including documentation, billing guidelines, related codes, and FAQs.

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What is CPT code 23350?

CPT code 23350, maintained by the American Medical Association, describes an injection procedure for shoulder arthrography involving injecting a contrast dye into the shoulder joint. Healthcare providers, typically radiologists or orthopedic specialists, perform this injection under image guidance—such as fluoroscopic arthrogram imaging, CT, or MR arthrogram—to enhance visualization of the shoulder's internal structures. The injection of contrast dye helps identify conditions affecting soft tissues, such as labral tears, rotator cuff injuries, or adhesive capsulitis. The 23350 CPT code specifically includes needle placement, use of a localization device if necessary, and injection of contrast dye into the shoulder joint as the primary procedure, facilitating subsequent imaging studies performed in the radiology department.

What is a shoulder arthrogram injection?

A shoulder arthrogram injection involves injecting a contrast dye directly into the shoulder joint to enhance imaging clarity during fluoroscopic, CT, or MRI shoulder arthrography. This procedure helps healthcare providers accurately visualize soft tissues within the joint, such as ligaments, tendons, labrum, and cartilage. Typically performed when standard X-ray or MRI scans are insufficient, it aids in diagnosing injuries or abnormalities such as labral tears or rotator cuff pathology.

CPT code 23350 documentation requirements

Proper documentation ensures compliance and supports accurate billing and coding practices:

Clinical indication

Clearly document the specific clinical indication for the shoulder joint injection procedure, such as suspected labral tear, adhesive capsulitis, or rotator cuff pathology.

Injection technique and laterality

Provide detailed descriptions of the injection procedure, including needle placement, injection technique, and clearly indicate laterality (right shoulder [RT] or left shoulder [LT]) for accurate billing.

Contrast agent type and volume

Document the type and volume of the injected contrast dye precisely, as this information confirms the procedure's scope and supports medical necessity.

Imaging guidance utilization

If fluoroscopic, CT, or ultrasound imaging was used to guide the injection, clearly document this method, as it impacts billing and reinforces accuracy.

Patient tolerance and adverse reactions

Include notes on patient tolerance, response to the procedure, and any adverse reactions or complications encountered during the injection.

Post-procedure instructions

Clearly document the instructions given to the patient post-injection, such as activity modifications, pain management, or follow-up imaging schedules.

Follow-up imaging details

Specify if subsequent CT or MR arthrogram imaging was performed following the injection, detailing the type of magnetic resonance (e.g., proton imaging) or CT arthrogram used.

CPT code 23350 billing guidelines

Accurate billing practices improve reimbursement compliance for CPT code 23350:

Bill once per shoulder joint injection

Report CPT 23350 only once per shoulder joint injection procedure, even if multiple images or needle placements occur.

Image guidance separately billable

If fluoroscopic (77002), CT (77012), or ultrasound guidance (76942) is used, bill these imaging codes separately, documenting the medical necessity clearly.

Use laterality modifiers

Always append modifiers (-LT or -RT) to specify the shoulder joint treated, ensuring clarity and accurate reimbursement.

Differentiate therapeutic injections

Do not bill CPT 23350 for therapeutic joint injections (e.g., steroid or anesthetic injections). Use CPT code 20610 instead for therapeutic injections unrelated to contrast-enhanced imaging.

Report imaging separately

Report diagnostic imaging studies performed after injection (such as X-ray, CT, or MRI) separately from CPT 23350, as these are distinct from the injection procedure itself.

Other relevant CPT codes

77002 – Fluoroscopy guidance for needle placement
77012 – CT guidance for needle placement
76942 – Ultrasound guidance for needle placement
20610 – Therapeutic joint injection (non-contrast)
73222 – MRI shoulder arthrography imaging, with contrast injection

Frequently asked questions

Yes, CPT code 23350 can be billed without separate imaging guidance codes, but typically imaging guidance (fluoroscopy, CT, or ultrasound) is utilized for precise needle placement and billed separately.

Yes. CPT 23350 specifically covers injecting a contrast dye into the shoulder joint. MRI shoulder arthrography imaging (CPT 73222) performed after the injection is billed separately, clearly documented as a separate procedure.

Report CPT 23350 twice, using modifiers -LT (left shoulder) and -RT (right shoulder) to indicate injections performed on each shoulder clearly. This ensures accurate reimbursement for bilateral procedures.