Radiology Coding Alert

If you've been looking for proof of the adage that just because there's a code for a service that doesn't mean payers will cover it, look no further than the 2008 cardiac MRI codes.

In the 2008 Physician Fee Schedule final rule, CMS states, "Upon review of the new cardiac MRI codes, we recognize that four of the new codes incorporate blood flow measurement, which remains one of the nationally noncovered indications for MRI in the Medicare program. Due to a national noncoverage determination for MRI that provides blood flow measurement, CPT codes 75558, 75560, 75562 and 75564 will not be recognized by the Medicare program."

These codes are:

On the other hand, CMS will reimburse practices for the other new codes in this group:

Impact: Now that the odd-numbered codes are your only hope for collecting reimbursement for the new cardiac MRI code series, you can't afford denials for the four payable codes in this range. Starting Jan. 1, if the physician simply indicates that he used contrast, you're limited to 75557 and 75559 -- even if the physician performed the MRI without contrast and then with contrast (which would warrant 75561 and 75563 if documented properly).

"Our current reports only tell us that contrast was used," says Yvette Hofmeister, CPC, coding analyst for OSU Internal Medicine in Ohio.-"The reports will need to be altered to indicate the test results without contrast and then again with contrast."