Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the provider ordered a ‘functional MRI’ of the brain. I reported 70557 and received a denial. What went wrong?

Idaho Subscriber

Answer: It’s difficult to tell for sure, but it’s likely you meant to choose the nonoperative brain MRI code, and you chose an operative brain MRI code.

Do this: Go back and check the notes to see what type of MRI it was. Since you mention that the notes read “functional MRI,” your most logical code choices would be 70554 (Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration) or 70555 (… requiring physician or psychologist administration of entire neurofunctional testing). The clue is that the word “functional” appears in the notes and in these code descriptors — unlike the other brain MRI codes.

You will have to check to be sure, but this doesn’t look like an intraoperative brain MRI, which you’d report with one of the following codes:

• 70557 (Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material)
• 70558 (… with contrast material(s))
• 70559 (… without contrast material(s), followed by contrast material(s) and further sequences).