Radiology Coding Alert

Keep tabs on which of these codes require direct supervision Medicare supplies you with a national coverage determination (NCD) for magnetic resonance angiography (MRA), but that doesn't mean coding these services is cut-and- dried. Make sure you're making the grade with this in-depth look at head MRA coding. Don't Fall Prey to the 'With Contrast' Trap CPT lists the following head MRA codes: 70544 -- Magnetic resonance angiography, head; without contrast material(s) 70545 -- ... with contrast material(s) 70546 -- .. without contrast material(s), followed by contrast material(s) and further sequences. Key: Do not report 70544 with 70545 for head MRA without contrast followed by head MRA with contrast. Report only 70546 for these services. The contrast supply codes you're most likely to report with these services (when your facility bears the cost of the contrast) are the following, said Debra P. Ferenc, BS, CPC, CPC-H, CMSCS, CMC, senior consultant and educator with MRCE, during her audioconference for The Coding Institute, "Radiology Coding Fundamentals": Q9952 -- Injection, gadolinium-based magnetic resonance contrast agent, per ml Q9953 -- Injection, iron-based magnetic resonance contrast agent, per ml Q9954 -- Oral magnetic resonance contrast agent, per 100 ml. Watch out: CPT guidelines state that "with contrast" in a code descriptor means "contrast material administered intravascularly, intra-articularly or intrathecally." You should not consider a study to be "with contrast" if the patient only receives oral and/or rectal contrast. In other words, don't think that just because you report contrast code Q9954 (oral contrast) you should report "with contrast" MRA code 70545. You can't count oral contrast as "with contrast," according to CPT. Tip: If HCPCS doesn't have a code for the contrast used, you should report A4641 (Radiopharmaceutical, diagnostic, not otherwise classified). Check Out What the MRA NCD Reveals The MRA NCD describes covered conditions but does not list covered ICD-9 codes. Crucial: Diagnosis codes that payers cover for MRA may differ, but you should never choose a diagnosis code based on coverage. Stick to coding the diagnosis your physician's documentation supports. Check it out: You can find the MRA NCD by searching the Medicare NCD database available at www.cms.hhs.gov/mcd/search.asp. Search for document ID "220.3." Payers may consider head MRA services (70544-70546) medically necessary for the following, Ferenc points out: vascular dementia hemiplegia migraine trigeminal nerve disorders occlusion and stenosis visual disturbances paralytic strabismus cerebral thrombosis or embolism fracture subdural or extradural hemorrhage following injury arterial or venous injury. Example: The physician documents a head MRA without/with contrast for a patient diagnosed with cerebral thrombosis, so you report 70546 and a code from the 434.0x range (Cerebral thrombosis ...). Distinguish TC and 26 Requirements Head MRA codes 70544-70546 all have both technical and professional components, Ferenc says. [...]