CPT 25246: Wrist Arthrography Contrast Injection
Headline: CPT code 25246 defines wrist arthrography contrast injection — a targeted diagnostic procedure for assessing intra-articular wrist pathology.
Lead: CPT code 25246 represents the percutaneous injection of contrast into the wrist joint to facilitate arthrography, an imaging technique that enhances visualization of cartilage, ligaments, and bony surfaces to diagnose tears, degenerative changes, and unexplained pain. This procedure plays a central role in the diagnostic pathway for complex wrist conditions and can inform both conservative and surgical management.
Why it matters: Nationally, accurate use and documentation of CPT code 25246 affect imaging utilization patterns, reimbursement flows to radiology and orthopedic practices, and the diagnostic workup for wrist pathology. Appropriate coding ensures clinical clarity and supports claims processing across public and private payers.
Payers covered: Analysis typically includes major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: This publication provides benchmarks for utilization and reimbursement where available, clarifies the clinical context and typical sites of service for CPT code 25246, and summarizes coding considerations and common modifiers (list provided). It also outlines implications for imaging workflows and documentation practices. Data not available in the input will be noted where applicable.
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Billing Code Overview
CPT code 25246 describes the injection of contrast dye into the wrist for arthrography, an imaging study used to evaluate internal joint structures such as cartilage, ligaments, and bone and to help diagnose joint conditions and unexplained wrist pain.
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Service type: Image-guided diagnostic arthrography procedure
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Typical site of service: Outpatient radiology or ambulatory surgical center; may also be performed in hospital outpatient imaging departments depending on clinical setting
Clinical & Coding Specifications
Clinical Context
A 46-year-old patient presents to the outpatient radiology department with persistent dorsal wrist pain and intermittent mechanical locking after a fall six weeks prior. Physical exam demonstrates focal wrist joint tenderness and limited range of motion suggesting intra-articular injury. The orthopedic surgeon orders a wrist arthrogram to evaluate internal joint structures for suspected triangular fibrocartilage complex (TFCC) tear, occult intra-articular fracture, or radiographically occult cartilage or ligament injury prior to MRI or wrist arthroscopy.
The clinical workflow: the patient is consented and screened for contrast allergy and anticoagulation. The procedure is performed in a radiology procedure room or fluoroscopy suite. Using sterile technique, the provider localizes the wrist joint under fluoroscopy, anesthetizes the entry site, and injects iodinated contrast into the radiocarpal (and if indicated midcarpal or distal radioulnar) joint space. Fluoroscopic images are obtained to document contrast distribution and to detect intra-articular pathology. Contrast injection may be performed immediately prior to MRI when MR arthrography is planned. Post-procedure monitoring is brief and discharge instructions are provided.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician's professional component separate from technical imaging services. |
TC | Technical component | Use when billing only the technical component (equipment, personnel) of the procedure. |
59 | Distinct procedural service | Use when the arthrography is a separate and distinct service from another procedure on the same day (e.g., unrelated injection). |
51 | Multiple procedures | Use when multiple procedures were performed the same day and payer requires reporting of multiple-procedure status. |
52 | Reduced services | Use when the service was partially reduced or not completed as originally intended. |
53 | Discontinued procedure | Use when the procedure was started but discontinued due to extenuating circumstances. |
76 | Repeat procedure by same physician | Use when the same physician repeats the injection or imaging on the same day. |
59 | Distinct procedural service | Use to indicate the arthrography is distinct from other same-day services (duplicate of above for emphasis). |
RT | Right side | Use to indicate the procedure was performed on the right wrist. |
LT | Left side | Use to indicate the procedure was performed on the left wrist. |
23 | Unusual anesthesia | Use when general anesthesia or MAC was required in addition to local anesthetic for a patient who has an otherwise reportable reason. |
52 | Reduced services | Use when full volume contrast or complete imaging could not be performed and service was reduced (duplicate handled above). |
22 | Increased procedural services | Use when the procedure required substantially greater resources or time than usual and documentation supports it. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RC0000X | Radiology – Diagnostic Radiology | Interventional radiologists and diagnostic radiologists commonly perform fluoroscopically guided wrist arthrography. |
| 208000000X | Orthopedic Surgery | Orthopedic surgeons may perform joint injections and arthrography in procedural suites prior to operative planning. |
| 2086S0102X | Sports Medicine | Sports medicine physicians evaluate traumatic wrist injuries and coordinate diagnostic arthrography. |
| 363L00000X | Family Medicine | Family physicians in some settings perform joint injections and coordinate imaging referrals. |
| 2084P0800X | Hand Surgery | Hand surgeons perform and interpret wrist arthrography findings for operative planning. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M24.231 | Recurrent dislocation, right wrist | Arthrography can evaluate recurrent instability and internal derangement. |
M24.232 | Recurrent dislocation, left wrist | Same relevance for the left wrist side. |
S63.501A | Unspecified sprain of right wrist, initial encounter | Used for evaluation of ligamentous injury after acute sprain guiding arthrography. |
S63.502A | Unspecified sprain of left wrist, initial encounter | Left wrist counterpart for acute sprain. |
M25.531 | Pain in right wrist | Symptom-based indication to evaluate intra-articular pathology. |
M25.532 | Pain in left wrist | Left-sided symptom code. |
M19.041 | Primary osteoarthritis, right wrist | Arthrography may assess joint space and degenerative changes contributing to symptoms. |
S62.91XA | Unspecified fracture of wrist and hand, initial encounter | Used when occult intra-articular fracture is suspected and arthrography is performed to delineate intra-articular extension. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
25246 | Arthrography, wrist, radiological supervision and interpretation with injection of contrast | Primary procedure: injection of contrast into the wrist joint and fluoroscopic supervision and interpretation. |
73030 | Radiologic examination, wrist; 2 views | Often performed before or after arthrography to evaluate osseous injury and joint alignment. |
76000 | Fluoroscopic guidance for needle placement (eg, arthrography) | Used when fluoroscopic guidance is reported separately for needle localization if payer requires separate reporting. |
72020 | Radiologic examination, forearm, 2 views | May be performed when suspected injury involves the distal forearm in addition to wrist. |
73221 | Magnetic resonance (MR) imaging, any joint of upper extremity; without contrast material(s) | MR imaging may follow arthrography when non-contrast MRI is ordered. |
73225 | Magnetic resonance (MR) imaging, any joint of upper extremity; with contrast material(s) | MR arthrography protocols sometimes include MR with intra-articular contrast obtained after 25246. |