Radiology Coding Alert

Question: When we receive orders for both a head and neck MRA (magnetic resonance angiography), we have been reporting two exams. We assign 70541 with modifier -76 (Repeat procedure by same physician) and bill twice. Our billing department says this is wrong. Can you help?

North Carolina Subscriber

Answer: Prior to calendar year 2001, you would have been incorrect. The CPT code descriptor for 70541 said "head and/or neck" and so could be reported only once in this scenario.

However, CPT 2001 assigned a set of magnetic resonance angiography codes for both the head and neck. There are now six codes to describe various services that previously could be reported only with a single code. There are two classifications one for the head and one for the neck and each category has three specific MR angiography codes within it to describe "with," "without" and "without followed by with" contrast.

Head

Neck

Most radiologists feel this was a big improvement because professionals have long recognized MR angiography of the head and of the neck as separate procedures. One example of how MRA would be used for the head and neck, independently of each other, is with patients who have had a cerebral vascular accident (CVA). The radiologist may want to conduct MR angiography of the brain and then, later, conduct a separate study of the neck vasculature, as well. These would represent completely different studies. In this instance, both codes should be billed and paid.

Reader Questions and You Be the Coder were reviewed by Gary Dorfman, MD, FACR, FSCVIR, president of Health Care Value Systems in North Kingstown, R.I.; and Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm.