Radiology Coding Alert

Question: What is the appropriate way to bill MRI of the brain and IACs?--'If two studies are performed, is it appropriate to bill MRI of the brain two times?

New Jersey Subscriber


Answer: You may only report two brain MRIs (70551-70553) if the physician performs and documents separate and distinct exams for the brain and IACs (internal auditory canals) with separate and distinct indications for each.

Watch for: A few additional sequences of the IACs does not count as a separate exam.

Even if you meet the separate-and-distinct requirements, your payer is unlikely to cover the second service. Some payers may suggest appending modifier 22 (Unusual procedural services) if you take extra images -- just remember that the extra work required and the extra scrutiny modifier 22 brings may not be worth the trouble.

Careful: Some practices document the IAC scan separately and use orbit, face, and neck MRI codes 70540, 70542, and 70543 for the IAC. But you shouldn't use these codes for this service unless your payer instructs you in writing to do so.