Radiology Coding Alert

Question: Can we bill for two scans (CPT 70553 and CPT 70540 ) on the same day when we are doing an MRI of the brain and internal auditory canals (IACs)? A few radiologists in our office say no, that we should assign only the code for the brain study.

Iowa Subscriber  
Answer: The separate coding of these two examinations depends not only on what was ordered by the referring physician but the manner in which the examinations were performed. In many practices, the IACs are studied in conjunction with the brain MRI, with or without additional sequences. Therefore, while additional attention might be focused on the anatomic area based on the patient's signs and symptoms and the suspected diagnoses, no additional examination is  performed. In these circumstances, no additional CPT code should be coded or billed.
 
If two separate and distinct MRIs of each of the anatomical parts were ordered and performed (not merely additional sequences during a single study), both should be coded and billed. If a study without contrast was performed, followed by a study with contrast, 70553 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material, followed by contrast material[s] and further sequences) is reported. In the past, 70540 (Magnetic resonance [e.g., proton] imaging, orbit, face, and neck; without contrast material[s]) would be appropriate for an IAC study without contrast. CPT changed its instructions for reporting procedures that are not described exactly by an established code. Therefore, as of Jan. 1, 2002, an MRI of the IACs should be billed using 76499 (Unlisted diagnostic radiologic procedure). In addition, modifier -59 (Distinct procedural service) should be appended to indicate separate and distinct procedural services were performed. Although there are no Correct Coding Initiative edits for these code combinations, some payers may assume they are bundled if clear, separate and distinct indications for both studies are not well documented.