Neurology & Pain Management Coding Alert

Anatomy only the beginning when looking for right MRI code.

Patients that report to your practice for magnetic resonance imaging (MRI) testing present a myriad of coding challenges.

You have to know several key details to code your MRIs correctly, and those details will likely change depending on the encounter and patient condition.

Read on for more information on how to choose the optimal MRI code each time your providers perform one.

Use This MRI Definition

Before getting into the coding aspect, it’s helpful to have a working definition of MRI. MRIs are like X-rays, so they are very specific to body areas and body systems. They create a detailed cross-sectional image of the patient’s internal organs and structures that the provider can examine to determine the patient’s condition.

MRIs are non-invasive and (supposedly) painless—unless the patient doesn’t fancy the idea of being placed on a table and slid into a tube-like structure.

Rely on Entire Family of MRI Codes

When looking up MRIs in the CPT^® manual, you’ll notice that MRIs are broken down very specifically, and there are different codes depending on specific body part, laterality, etc.

According to Beth Fink, MRA coding specialist at Humana in Louisville, Kentucky, this is required due to the specificity of the test.

You’ll find dozens of different MRI codes “because there are so many different body parts and the specificity of [an MRI for] each one,” Fink explains.

Some of those specifics include:

• Anatomical area;
• With or without contrast material;
• Specified locations on each bone: proximal, distal, shaft, styloid process;
• Bilateral, left, right; and
• Presence or absence of physician or psychologist for neurofunctional testing

Best bet: Pay attention to the specifics of each MRI encounter; the key to the specific code you seek could be hiding in plain sight on the encounter form. You just have to know where to look.

MRIs Are Often Helpful for Headache Patients

There are more possible reasons for MRIs than there are CPT^® codes for MRIs; in short there are a lot of conditions that could merit an MRI. According to the Mayo Clinic, “MRI is most frequently used imaging test of the brain and spinal cord”; but that’s not the only conditions your provider might use MRI to identify or evaluate.

Some of the other conditions that patients commonly have evaluated with MRI include:

• Headache,
• Back injuries,
• Joint/limb pain,
• Generalized pain,
• Aneurysms of cerebral vessels,
• Disorders of the eye and inner ear,
• Multiple sclerosis (MS),
• Spinal cord disorders,
• Stroke,
• Tumors, and
• Brain injury from trauma.

Note: This is not a comprehensive list of all the conditions that might be treated with MRI. Always code to the encounter notes, and check with a provider or payer if you are unsure about your MRI code choice.

Compare Contrast/Without Contrast Codes

One of the most common components you’ll have to know about your MRI is whether or not the provider used contrast material. According to Fink, contrast material isn’t always used in an MRI. “It just depends on the situation. I would say 50/50.”

When to use: Contrast is only used when there needs to be a better enhancement of body tissue. Patients with inflammations will more than likely have contrast ordered. The main usage of intravenous (IV) contrast in MRI is in the detecting of benign or malignant tumors and for the staging of tumors of the central nervous system and major body organs.

Bone tumors are often less visible with contrast on MRI examinations. For example, the main reason for ordering a contrast MRI in a stroke patient is to rule out a brain tumor or aneurysm. After those unexpected diagnoses are ruled out, a stroke patient can be successfully followed with non-contrast MRI.

Acoustic neuromas, central nervous system aneurysms, vascular malformations, and causes for seizures are more completely evaluated with contrast on MRI examinations. Meningitis can benefit from contrast MRI in diagnosis and follow up.

When not to use: However, sports injuries, work-related injuries, and back pain do not require intravenous contrast MRI examinations and intravenous contrast usually adds nothing to the examination.

Dive Deeper Into Contrast Material Question

With/without is not the only contrast material question you could be answering when coding for an MRI. Some MRIs differentiate between “with contrast material” and “without “without contrast material, followed by contrast material[s] and further sequences.”

For example, codes 73219 (Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)) and 73220 (… without contrast material(s), followed by contrast material(s) and further sequences) illustrate this concept.

The difference between the two tests “is the details that are enhanced by the contrast,” explains Fink. “So, the 73219 is alone and no contrast at all; whereas 73220 has both without and with contrast. This is so that [the MRIs] can be compared to each other, and the contrasted one will show more detail. “

Consider This MRI Example

As we’ve already mentioned, there are a lot of MRI codes out there, and with that the possibility of a lot of different MRI codes popping up on claims. Consider this PM-specific MRI coding example:

A PM specialist orders an MRI to rule out tumors on the spine, which may be causing the extreme pain experienced by a patient in their thoracic area for a prolonged period of time. They may order it without contrast or with/without contrast. You’d choose from the following codes for this encounter, depending on specifics:

• 72146 (Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material)
• 72157 (Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic)

Modifier alert: If the provider performed the MRI using equipment owned by another entity (hospital, ambulatory surgery center [ASC], etc.), append modifier 26 (Professional component) to the MRI code. This shows that you are just coding for the provider’s services, not the use of the MRI equipment.

If the provider performed the MRI using equipment owned by your practice, you don’t need a modifier for this service.