Radiology Coding Alert

Question: Is there a specific number of "without contrast" views required to qualify for a code such as 71552?

Pennsylvania Subscriber

Answer: You're unlikely to find a coding instruction on the number of slices or views required for CT and MRI codes that describe without and with contrast imaging, such as 71552 (Magnetic resonance [e.g., proton] imaging, chest [e.g., for evaluation of hilar and mediastinal lymphadenopathy]; without contrast material[s], followed by contrast material[s] and further sequences).

Before you select your code, however, you will want to be sure you check the treating physician's order. If the ordering physician considers without and with contrast imaging to be medically necessary and the radiology team provides and documents without and with contrast images, you should report the corresponding "without and with" code.

Additionally, if the order does not specify such details, Medicare allows the interpreting physician to make the decision under the "Test Design" concept. Medicare Benefit Policy Manual, Chapter 15, section 80.6.4, states:

Unless specified in the order, the interpreting physician may determine, without notifying the treating physician/practitioner, the parameters of the diagnostic test (e.g., number of radiographic views obtained, thickness of tomographic sections acquired, use or non-use of contrast media).

Tip: For more information on diagnostic test ordering rules, review all of section 80.6, available at www.cms.gov/manuals/Downloads/bp102c15.pdf.