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Ophthalmology and Optometry Coding Alert

Reader Question:

Check Carrier Policy Before Coding MRIs for Strabismus

Published on Sun Dec 01, 2002

Question: When is an MRI covered if the diagnosis is strabismus? Kentucky Subscriber Answer: Great question. Unfortunately, carriers' policies vary on coverage for magnetic resonance imaging (MRI).

Most Medicare carriers are of the opinion that not all patients with the diagnosis of strabismus (378.50-378.63) require an MRI. Acute, sudden onset of strabismus, strabismus as a result of trauma, and congenital strabismus are three conditions by which many payers cover MRIs.

Pay close attention to the MRI code definitions when choosing the MRI code to correspond to the diagnosis of strabismus. MRI codes are organized according to the area of the body examined. The strabismus-related MRI codes, those for the orbit, face and neck, include:

70540 Magnetic resonance (e.g., proton) imaging, orbit, face, and neck; without contrast material(s)
70542 with contrast material(s)
70543 without contrast material(s), followed by contrast material(s) and further sequences.  
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