# same-day MRI/MRA head



## jewelrad

how do you bill for MRI/MRA head done on same-day?
the physician ordered MRI&MRA of head for the medicare patient. the patient encountered once and MRI&MRA are done.
we should report this service with 70551(MRI head) and 70544(MRA head) with modifier 59 to receive payment on both MRI and MRA head according to the CCI Edits.
how do you manage same-day MRI/MRA head in your practice?


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## AuntJoyce

*Same Day MRI/MRA*

Good morning,

Indeed, you will bill it exactly as you have stated with the -59 modifier appended to the 70544.

Beware, you will more than likely have to appeal this on paper since many carriers automatically deny the second study (incorrectly).

I worked for a Radiology billing company for quite some time and this was the main denial set.  After a while, when we first submitted these charges, we automatically made the copies so that we would not have to track it down later on.  As soon as the denial hit, we popped a stamp on the envelope and off it went.

Good luck!

Joyce


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## krishna.k

Hi,

Please see below also this will help for you.
MRI/MRA Head		
code pair	70544-59	 70551
code pair	70544-59	 70552
code pair	70544-59	 70553
code pair	70545-59	 70551
code pair	70545-59	 70552
code pair	70545-59	  70553
code pair	70546	 70551-59
code pair	70546	 70552-59
code pair	70546-59	 70553

Thanks,
KrishnaCPC


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## Lizz B

*MRI with MRA*

What are the requirements for billing both MRI and MRA done during same session?  (I code OP ancillary services at an acute care facility).  My CT/MR Coder reference states only that it is appropriate to bill for both, assuming full and complete studies of each are performed, and yet when billed at the same time, our editing software kicks them out for CCI edits.  I understand that I may add modifier 59, but WHEN is it appropriate to do so? If the radiologist gives a complete report on the MRI and then under 'MRA' notes 'no acute findings', 'negative study', or 'see above', am I justified in billing for both?

Any help would be greatly appreciated, along with a suggestion of reference sources for such things!

Thanks much!


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## ghiocel

*mri/mra denial*

I have the same situation, Medicare dined MRI of the brain and MRA of the head,done on the same session, stating modifier missing or invalid. What should I do in this case?I have two report done, one for MRI of the head and MRA of the head.


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## lornyllm

*mri/mra done on the same day*

Has anyone even gotten paid by medicare when they append the mra with modifier 59? I work for a radiology company and we have the same problems with medicare and some of the private insurances denying the second study as cannot be performed on the same day.  Anyone have any thoughts or suggestion how to handle this issue.  Most of our referring doctors would rather have the study done the same day and not have to bring the patients back.


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## jpproctor

AuntJoyce said:


> Good morning,
> 
> Indeed, you will bill it exactly as you have stated with the -59 modifier appended to the 70544.
> 
> Beware, you will more than likely have to appeal this on paper since many carriers automatically deny the second study (incorrectly).
> 
> I worked for a Radiology billing company for quite some time and this was the main denial set.  After a while, when we first submitted these charges, we automatically made the copies so that we would not have to track it down later on.  As soon as the denial hit, we popped a stamp on the envelope and off it went.
> 
> Good luck!
> 
> Joyce



If CMS normally considers the MRA part of the MRI when performed during the same session, and we break it down to bill separately by adding modifier 59 to the MRA, what specifically does our documentation need to note to justify the split?  Any help is appreciated.


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## jgf-CPC

*Mra*

According to CMS it is appropriate to append the 59 mod to the 70544. There are times when we do have to appeal but normally get paid eventually.


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## jpproctor

jgf-CPC said:


> According to CMS it is appropriate to append the 59 mod to the 70544. There are times when we do have to appeal but normally get paid eventually.



Thank you Jackie. I guess my main concern is my documentation. What do I use to appeal? (Can't help but wonder why the codes were combined in the first place if we are allowed to bill 70544 w/mod 59 if done at the same time as the MRI. Seems counterproductive.) Also wondering if this same approach can be used for all the other codes that are now combined such as the CT/CTA, CT Orbits/CT Brain, Ultrasound/Vascular. It's easy to do this when these exams are done at different times of the day, but when done in the same session, we are unclear how they can fall within the guidelines of the correct usage of modifier 59 and stand up to an audit and can find nothing written to help my staff & me understand. Thanks for your help.


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## jpproctor

jpproctor said:


> Thank you Jackie. I guess my main concern is my documentation. What do I use to appeal? (Can't help but wonder why the codes were combined in the first place if we are allowed to bill 70544 w/mod 59 if done at the same time as the MRI. Seems counterproductive.) Also wondering if this same approach can be used for all the other codes that are now combined such as the CT/CTA, CT Orbits/CT Brain, Ultrasound/Vascular. It's easy to do this when these exams are done at different times of the day, but when done in the same session, we are unclear how they can fall within the guidelines of the correct usage of modifier 59 and stand up to an audit and can find nothing written to help my staff & me understand. Thanks for your help.



Found the answer to my questions regarding documentation on the ACR website and wanted to share:  

"Question:  Is it appropriate to report an MRI brain code for the axial images acquired as part of an MRA study? If not, when is it appropriate to report both brain MRI and brain MRA codes? 

No, it is not appropriate to report a magnetic resonance imaging (MRI) brain code for the axial source images acquired as part of a magnetic resonance angiography (MRA) study.  The axial source images are an integral portion of the MRA examination. While some lesions may be visible on the MRA axial source images, these images are specifically designed to minimize brain parenchymal resolution in order to optimize visualization of the vasculature.  

Only when a full and complete brain MRI is performed separate from a full and complete MRA examination (separate data set acquisition) would it be appropriate to report both an MRI and MRA code.    When medically necessary, MRI and MRA exams can be complementary. MRI and MRA of the brain represent separate procedures, each with a distinct anatomic target - the nervous system (extra-vascular) and its vascular system (intra-vascular).   The two procedures employ distinctly different imaging protocols, and separate reports are generated. In this instance, the use of modifier 59 is appropriate, even though the distinct anatomic targets are both intracranial in location.  As noted in the AMA's Coding with Modifiers guide, in order to use modifier 59, documentation needs to be specific to the distinct procedure or service and be clearly identified in the medical record." 
Thanks to all who helped with this one, it's much appreciated.


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## nelsong5

http://medicare.fcso.com/coverage_fi...lcd_search.asp

This link will help you find any LCD (as long as there is one) about any CPT code you want to search for. Just put the CPT code in the box where it says procedure code and it will appear slight under the LCD ID box.

Now to help you guys with the MRI and MRA. MRIs and MRAs are procedures that are essentially the same when describing the technical component of the study (Both are images, but MRIs are more specifically for soft tissue evaluation and MRAs for artery visualization with the use of contrast material). Therefore, since the procedures are similar to one another you need to add a modifier (-59) to the MRA studies in order to get paid because it is a separately identifiable procedure from the MRI procedure. Now remember that the referring doctors needs to document his medical necessity very accurately to avoid overpayment. 

Now for the CT Scans of the brain and orbits. These procedures are extremely similar because the CT Scan will catch traverse images of the brain and the orbits all together when the technician is performing the procedure. This leads to insurance companies calling it a duplicate because both parts are included in one study. One way to avoid this is just have the patient do the head scan in one day and come back another day and do the orbit scan. Remember that your doctors need to document correctly the medical necessity. 

Hope this helps, feel free to reply with any questions.


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## genenut

*59 or xu*

With the addition of the x modifiers would  you bill this combination with a 59 still or an XU modifier instead ?


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## chembree

The below information is directly from the NCCI manual


                                    CHAP9-CPTcodes70000-79999_final103115.doc 
                                                Revision Date: 1/1/2016 
                                                       CHAPTER IX 
                                              RADIOLOGY SERVICES 
                                           CPT CODES 70000 - 79999 
                  FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES

9. Computed tomography (CT) and computed tomographic angiography (CTA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate CT and CTA reports, only one procedure, either the CT or CTA, for the anatomic region may be reported. Both a CT and CTA may be reported for the same anatomic region if they are 
performed at separate patient encounters or if two separate and distinct technical studies, one for the CT and one for the CTA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon. 
Similarly magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate MRI and MRA reports, only one procedure, either the MRI or MRA, for the anatomic region may be reported. Both an MRI and MRA may be reported for the same anatomic region if they are performed at separate patient encounters or if two separate and distinct technical studies, one for the MRI and one for the MRA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon


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## luciacarey

*MRI/MRA Denials*

I am just wondering what you all include with your denials for MRI/MRAs.  BCBS is out of control with denying these codes.  Is there any special documentation, rules, guidelines that you all send with your appeal letters?


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## srosario28

Can you bill CPT codes 70544, 70547 and 70551all together?


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