Radiology Coding Alert

Question: Could you please help me with the following scenario: A Medi-cal (California Medicaid) patient had a brain MRI with and without contrast. The diagnosis in the report states that the patient has metastatic lung cancer, which required screening for brain metastases. Is there an acceptable ICD-9 code that would be used in this situation?

Maggie Kissinger
Diversified Billing, Lafayette, Calif.

Answer: According to Medicare, an entire range of neoplasm codes are considered covered diagnoses for an MRI (magnetic resonance imaging) of the brain. This range includes 141.X (malignant neoplasm of tongue) through 208.9X (leukemia of unspecified cell type). Although this seems like a broad spectrum, it makes sense when you realize that many of these covered neoplasms put a patient at great risk for a brain metastasis. If your code falls within this coding range, you likely have a payable diagnosis.

In the instance described, code the lung neoplasm as the primary diagnosis. Choose from codes 162.3 (malignant neoplasm of trachea, bronchus, and lung; upper lobe, bronchus or lung), 162.4 (middle lobe, bronchus or lung), 162.5 (lower lobe, bronchus or lung), 162.8 (other parts of bronchus or lung) or 162.9 (bronchus and lung, unspecified).

The code assigned for the MRI may include 70551 (magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material), 70552 (with contrast material[s]), or 70553 (without contrast material, followed by contrast material[s] and further sequences), depending on the procedure performed.

Source for this Reader Question is Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispecialty group practice in Buckhannon, W.Va.