Radiology Coding Alert

Pay careful attention to the new guidelines.

On Sept. 10, 2024, the AMA released the 2025 CPT^® code set, which features 420 updates, including 270 new codes. Among the new codes are six that will interest radiology coders handling magnetic resonance (MR) procedure coding.

Find out about the new radiology codes, so you’re prepared on January 1.

Refresh Your MRI Knowledge

Magnetic resonance imaging (MRI) equipment use powerful magnets to generate 3D views of the patient’s body structures. The noninvasive technology is used for diagnostic procedures or procedures performed under imaging guidance.

Due to the equipment’s strong magnetic field, having metal objects in the room can pose a hazard to the equipment, providers, and patients. Metallic items that should be left out of the imaging suite include sharp medical instruments, furniture, and even pens.

Simultaneously, patients might be in possession of metal items that they can’t leave behind in the waiting area. The MRI’s magnets can attract foreign bodies or implanted medical devices, which can cause injury or death.

As a result, radiologists must perform safety checks prior to the MRI procedure, either before or on the day of service.

Report MR Safety Planning Services With New CPT^® Codes

Effective Jan. 1, 2025, the CPT^® code set includes six new codes related to MR safety-planning services.

The following codes are designated for services performed in advance of the date of the MR procedure:

• 76014 (MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging), analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; initial 15 minutes)
• +76015 (… each additional 30 minutes (List separately in addition to code for primary procedure))
• 76016 (MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing MR examination, and determination of MR equipment, accessory equipment, and expertise required to perform examination, with written report)

You’ll assign 76014 when the technologist or MR safety-trained clinical staff documents the implant safety conditions, additional procedures, and contraindications. To report MR safety assessments longer than 15 minutes by clinical staff for patients with incompletely documented, complex, or multiple implants, you’ll use +76015. Code 76016 is reserved for devices that do not have MR conditional labeling, are contraindicated for MR, or “may result in a limited MR examination,” according to the CPT^® guidelines.

You’ll report MR safety services performed on the day of the MR examination with the codes listed below:

• 76017 (MR safety medical physics examination customization, planning and performance monitoring by medical physicist or MR safety expert, with review and analysis by physician or other qualified health care professional to prioritize and select views and imaging sequences, to tailor MR acquisition specific to restrictive requirements or artifacts associated with MR conditional implants or to mitigate risk of non-conditional implants or foreign bodies, with written report)
• 76018 (MR safety implant electronics preparation under supervision of physician or other qualified health care professional, including MR-specific programming of pulse generator and/or transmitter to verify device integrity, protection of device internal circuitry from MR electromagnetic fields, and protection of patient from risks of unintended stimulation or heating while in the MR room, with written report)
• 76019 (MR safety implant positioning and/or immobilization under supervision of physician or other qualified health care professional, including application of physical protections to secure implanted medical device from MR-induced translational or vibrational forces, magnetically induced functional changes, and/or prevention of radiofrequency burns from inadvertent tissue contact while in the MR room, with written report)

If medical physics services are provided during the exam, you’ll assign 76017 to report the safety services. But to report preparing and documenting that the implant is placed in a mode that is safe for use with the MR equipment, you’ll use 76018. Lastly, you’ll use 76019 to specify the positioning or immobilization of the implant during the exam.

Of course, all of the documented information associated with the new codes will need to be placed in the medical record.

Examine the New Guidelines

The CPT^® code set includes new guidelines before the codes in the Magnetic Resonance Safety Implant/Foreign Body Procedures section.

Medical implants may have labels approved by the U.S. Food & Drug Administration (FDA) that identify which conditions are safe for a provider to perform an MR examination. According to the guidelines, the conditions listed could include:

• Type of MR equipment
• Implant preparation prior to procedure
• Excluded anatomical regions
• MR scan time and energy deposition limitations
• Implant components that may contraindicate MR examination

Contraindication defined: As mentioned above, patients with certain implanted devices can face harm if safety procedures aren’t correctly performed. “In some instances, components of implanted devices can cause harm to the patient if introduced to the intense magnetic pull from an MR exam. These devices need to be identified, evaluated, and addressed before the MR exam can be performed,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services.

You may need to use additional codes depending on the patient’s implanted device(s). “Cardiac devices (eg, pacemakers and defibrillators) may require interrogation or programming services before or after the performance of the MR examination to put them in a mode safe for the MR scan,” according to CPT^® guidelines. In these cases, you’ll refer to the applicable cardiac device evaluation code.

At the same time, you may need to examine a neurostimulation device electronic analysis-programming code. According to the new guidelines, “… neurostimulation devices may require analysis programming before being placed into an MR-protective mode, or after the performance of the MR examination.”