Radiology Coding Alert

Make the most of modifiers for leg-joint imaging reports

You may be familiar with coding lower-body MRIs, but what happens when the radiologist images more than one joint? We'll show you how to breeze through selecting an accurate code and appending appropriate modifiers.

Straightforward Coding for a Standard MRI

Problem: You won't find "MRI; Hip" in your CPT Codes 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 radiologist's reading of the image, or append TC (Technical component) if you're reporting only the imaging itself. If you're part of an entity, such as a radiology office, that provides the interpretation and technical exam, 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 (meaning imaging of both 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 radiologist reviews bilateral hip MRIs performed on his own equipment with contrast. Report 73722-LT (... with contrast material[s]), 73722-RT-76.

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 - CPT Assistant (July 2001) tells you that to report bilateral studies you need to check your payer policies to determine the correct modifier to indicate two studies, says Rehna Burge, radiology coder at North Oaks Health System, a Hammond, La., medical center.

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.

Only use the MRI pelvis codes if the order is specifically for a pelvis MRI and/or the physician looks at the pelvic viscera, such as the organs and soft tissue, Scott says.

If you have an order for MRIs of both hips and the pelvis and written reports for all three services, you may claim all three. Experts warn: Before you code for multiple studies, be sure the documented clinical indications support them. You should also have full and complete exams of all the anatomic sites - not just one exam that superficially includes all of the sites - with complete reports for each coded exam.

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,  Burge says.

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, Burge adds.

Example: Your radiologist reads MRIs performed at a hospital. The patient had an MRI of the hip and of the knee of his left leg with and without contrast. His insurance company requires you to append modifiers to distinguish sides and to report two separate procedures that merit the same code. The MRI code you need is 73723 (... without contrast material[s], followed by contrast material[s] and further sequences). Report 73723-26-LT, 73723-26-LT-59.

Tip from the field: When you have a question about the proper use of a CPT code, you'd be wise to check with your local carrier, Burge says. If your carrier won't offer a specific answer, consider the descriptor and use your best judgment to decide the most ethical way to use the code, she adds. For 73721, for example, because the descriptor refers to "any joint" in the singular, you should feel comfortable reporting this code per joint and defending your choice in an audit.