Orthopedic Coding Alert

Make the most of modifiers for leg-joint imaging reports

Even if you-re familiar with coding lower-body MRIs, you may not know which code to report when the surgeon images more than one joint. We-ll show you how to select an accurate code and append the appropriate modifiers to your imaging claims.

Straightforward Coding for a Standard MRI

Problem: You won't find -MRI; Hip- in your CPT index. Instead, when the order is for a hip MRI, you should choose the proper code from 73721-73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity ...) because the hip is a joint, says Sandi Scott, CPC, PMCC, instructor and director of audit and training for InSight Health Corp. in Lake Forest, Calif.

Keep an eye out for whether you need to designate which aspect of the MRI you-re reporting, says Rhonda Jay, quality assurance specialist for Southwest Diagnostic Imaging in Dallas.

Append modifier 26 (Professional component) if you-re coding only the surgeon's interpretation of the image, or append TC (Technical component) if you-re reporting only the imaging itself.

Most likely, however, if you-re coding MRIs, your practice probably owns the equipment, and an employee performs the MRI itself, while a surgeon at your practice interprets the results and writes a report. In that case, you should report the global code without modifiers 26 or TC.

Bolster Your Bilateral Hip MRI Coding

If your documentation reveals a bilateral MRI of the hips, your modifier choice could be the difference between payment and denial.

Some payers--especially Medicare--seem to prefer that you report the MRI code with LT (Left side) and RT (Right side), Jay says. Texas Medicare has even suggested using LT and RT with 76 (Repeat procedure by same physician), she adds.

Example: The orthopedist reviews bilateral hip MRIs performed with contrast that a staff member administered using your practice's own equipment. In this situation, you should report 73722-LT (... with contrast material[s]), 73722-76-RT.
Other payers prefer that you use modifier 50 (Bilateral procedure) -to keep it simple,- Jay says.

Medicare recognized all joint MRI exams as eligible for bilateral payment as of Jan. 1, 2004, so securing reimbursement for this service should not be a problem--as long as you code according to your carrier.

Some payers require you to report the CPT code twice, appending 50 to the second code, while for others, you should report the code once and append 50 to indicate a bilateral procedure.

Bottom line: Codes 73721-73723 represent unilateral studies--the July 2001 CPT Assistant reminds coders that to report bilateral studies you need to check your payer policies to determine the correct modifier to indicate two studies.

Steer Clear of This Pelvis MRI Pitfall

When you need to code for bilateral hip MRIs, don't be tempted to report an MRI of the pelvis (72195-72197, Magnetic resonance [e.g., proton] imaging, pelvis ...). The CPT codes for a pelvis MRI are not joint codes, Scott says. When the order is for a hip MRI, only use the lower- extremity joint codes 73721-73723, she says.

Break Up Hip and Knee Claims

Even though these MRI joint codes (73721-73723) are unilateral, don't assume you can only code for one MRI when your patient requires an MRI of both the hip and knee on the same leg.

Reason: To perform an MRI, the provider obtains high-resolution images by using coils made specifically for different areas of the anatomy. Translation: You need separate coils for the hip and the knee to obtain detailed images, so the MRI of each joint is a separate procedure.

What to do: Report a lower-extremity joint MRI code once for each joint imaged. You may need to append 59 (Distinct procedural service), LT, or RT, depending on your payer's requirements.

Example: Your surgeon reads MRIs that a hospital radiology department performed. The hospital completed an MRI of the hip and knee of the patient's left leg with and without contrast, and his insurance company requires you to append modifiers to distinguish sides. You should report 73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity; without contrast material[s], followed by contrast material[s] and further sequences). Your code would include two separate line items, as follows:

- 73723-26-LT

- 73723-59-26-LT. 
 
Link each line item to the appropriate diagnosis code that demonstrates the applicable hip condition and the appropriate knee condition to confirm medical necessity of both studies.