Radiology Coding Alert
Dive Into Specifics to Properly Code MRIs
Contrast aids in detecting tumors in the body. Radiology practices see a variety of patients who require magnetic resonance imaging (MRI), and those procedures present a multitude of challenges from the coder’s perspective. From different anatomical sites to the possible use of contrast, you’ll need to carefully check the report’s details to assign the right MRI code. What Does an MRI Entail? MRIs are like X-rays, so they are very specific to body areas and body systems. They create a detailed cross-sectional image of the patient’s internal organs and structures that the provider can examine to determine the patient’s condition. MRIs are noninvasive and (supposedly) painless — unless the patient doesn’t fancy the idea of being placed on a table and slid into a tube-like structure. Rely on Entire Family of MRI Codes CPT® breaks down MRIs very specifically, and there are different codes depending on specific body parts, laterality, etc. According to Beth Fink, MRA coding specialist at Humana in Louisville, Kentucky, this is required due to the specificity of the test. You’ll find dozens of different MRI codes “because there are so many different body parts and the specificity of [an MRI for] each one,” Fink explains. Some of those specifics include: Best bet: Pay attention to the specifics of each MRI encounter; the key to the specific code you seek could be hiding in plain sight on the encounter form. You just have to know where to look. Diagnose Headaches Using MRIs There are more possible reasons for MRIs than there are CPT® codes for MRIs, and there are a lot of conditions that could merit an MRI. In fact, “MRI is the most frequently used imaging test of the brain and spinal cord” according to the Mayo Clinic (https://www.mayoclinic.org/tests-procedures/mri/about/pac-20384768), but that’s not the only condition your provider might use MRI to identify or evaluate. Some of the many conditions that patients commonly have evaluated with MRI include: Note: This is not a comprehensive list of all the conditions that might be evaluated using MRI. Always code to the encounter notes and check with a provider or payer if you are unsure about your MRI code choice. Understand the With Contrast and Without Contrast Code Differences One of the most common components you’ll have to know about your MRI is whether the provider used contrast material. Contrast material isn’t always used in an MRI. “It just depends on the situation. I would say 50/50,” Fink suggests. MRI uses contrast material only when body tissue needs to be better enhanced. Providers will more likely order contrast MRI for patients with inflammations, for example. Providers can administer contrast material to patients through different routes, including intravenous (IV) methods. The main usage of IV contrast in MRI is in the detecting of benign or malignant tumors and for the staging of tumors of the central nervous system and major body organs. Bone tumors are often less visible with contrast in MRI examinations. For example, the main reason a provider will order a contrast MRI for a stroke patient is to rule out a brain tumor or aneurysm. After the provider rules out these unexpected diagnoses, a stroke patient can be successfully followed with a noncontrast MRI. Providers can also more completely evaluate acoustic neuromas, central nervous system aneurysms, vascular malformations, and causes for seizures with contrast MRI examinations. Meningitis can also benefit from contrast MRI in diagnosis and follow-up. However, sports injuries, work-related injuries, and back pain typically do not require intravenous contrast MRI examinations, and intravenous contrast usually adds nothing to the examination. Uncover More Contrast Information With/without is not the only contrast material question you could be answering when coding for an MRI. Some MRIs differentiate between “with contrast material(s),” “without contrast material(s),” and “without contrast material, followed by contrast material(s) and further sequences.” For example, codes 73218 (Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)) and 73220 (… without contrast material(s), followed by contrast material(s) and further sequences) illustrate this concept. The difference between the two tests “is the details that are enhanced by the contrast,” Fink says. Code 73218 is alone and doesn’t use contrast at all, but 73220 has both without and with contrast. This allows the 73220 MRIs to be compared to each other with the contrasted one showing more detail. Consider This MRI Example A primary care provider (PCP) refers a patient to an oncologist after the patient experienced shortness of breath, wheezing, and pain in the chest for a prolonged period. The specialist orders an MRI to evaluate for tumors in the patient’s airways. You’d choose from the following codes for this encounter, depending on specifics: Modifier alert: If the provider performed the MRI using equipment owned by another entity, such as a hospital or ambulatory surgery center [ASC], append modifier 26 (Professional component) to the MRI code. This shows that you are coding just for the provider’s services, not the use of the MRI equipment. If the provider performed the MRI using equipment owned by your practice, you don’t need a modifier for this service.
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