Radiology Coding Alert
Payment for Abdominal MRAs
New Mexico Subscriber
Answer: The most common problem with physician reimbursement for MRAs of the abdomen (e.g., 74185, Magnetic resonance angiography, abdomen, with or without contrast material[s]) is that Medicare allows only a few circumstances to support medical necessity for this service. Although policies vary by carrier, most recognize an MRA of the abdomen only in preparation for repair of an abdominal aortic aneurysm (AAA). Coders should check their local medical review policy (LMRP) because states have slightly different payable diagnoses lists. In addition, it is wise to ask patients to sign an advance beneficiary notice (ABN) in the likelihood that Medicare will deny the claim. This allows the radiology practice to bill the patient for the service and not write off the expense.
In some instances, MRAs are performed in a hospital setting before procedures like AAA repair. The facility will bill the services with new C codes (C8900-C8914) found in the 2002 HCPCS Level II Professional Coding Manual.
Further details about these codes are in CMS program memorandum to intermediaries PM A-01-73. This includes a comprehensive list of changes to the hospital outpatient prospective payment system in regard to MRA studies with and without contrast. The PM was released in June 2001, effective October 2001. The codes outlined in the memo are for hospital outpatient claims only.
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