Pre-authorization snag may require ABN. You may find conflicting information in researching how to code MR urograms, says Suzanne C. Hoyt, senior billing specialist with Practicare Medical Management in New York. For example, you may come across sources that say to report both abdominal and pelvic MRIs, but you'll have to reconcile this advice with certain payers preauthorizing only an abdominal exam, she says. Protect yourself: 1. What did the treating physician order? 2. What did your facility perform and document? 3. What did the insurance company authorize? 1. Insist on Orders for Both Exams Be sure you have orders from the treating physician for both abdominal and pelvic MRI exams before you consider reporting both -- for example, 74183 (Magnetic resonance [e.g., proton] imaging, abdomen; without contrast material[s], followed by with contrast material[s] and further sequences) and 72197 (Magnetic resonance [e.g., proton] imaging, pelvis; without contrast material[s], followed by contrast material[s] and further sequences) for exams performed without and with contrast. Watch out: 2. Demand Distinct Documentation To support reporting both abdomen and pelvis MRIs, also be sure the radiologist has documented both exams clearly. Ideally, the radiologist will record each in a separate paragraph, describing the organs visualized and pertinent comments and findings. For example, the abdominal MRI documentation might focus on the kidneys and urinary collecting system for anatomical or physiological abnormalities. The pelvic documentation might assess any pelvic floor defects associated with urinary incontinence. Resource: • Abdomen: www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/gastro/mri_abdomen.aspx • Pelvis: www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/gastro/mri_pelvis.aspx. 3. Assess Need for ABN If the insurer preauthorizes only an abdominal MRI,then expect the insurer to reimburse only the abdominal MRI. The treating physician still may determine that both pelvic and abdominal MRI exams are necessary for the patient. In that case, alert the patient that he may be financially responsible for the pelvic MRI. Have him read and sign a waiver or Advance Beneficiary Notice (ABN) agreeing to cover the cost if he chooses to have the exam.For Medicare, append modifier GA (Waiver of liability statement issued as required by payer policy) to the pelvic MRI code to indicate you have an ABN on file. ABN alert: New modifier GX (Notice of liability issued, voluntary under payer policy) shows you provided "beneficiaries with voluntary notice of liability regarding services excluded from Medicare coverage by statute," CMS states.