Radiology Coding Alert

Question: A patient visited our radiology practice for an fMRI of their brain. During the encounter, the patient performed simple tasks when prompted by the radiologist. The radiologist captured images of the patient’s brain while the patient performed the tasks and during rest periods.

What is the difference between fMRI codes?

Michigan Subscriber

Answer: Choosing the correct functional magnetic resonance imaging (fMRI) code depends on the presence of a physician or psychologist during the examination. The CPT^® code set includes two fMRI procedure codes:

• 70554 (Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration)
• 70555 (… requiring physician or psychologist administration of entire neurofunctional testing)

You’ll assign 70554 to report an fMRI exam when a physician or psychologist isn’t present to administer the neurofunctional testing. On the other hand, if a physician or psychologist administers the neurofunctional tests, then you’ll assign 70555 to report the procedure.

Important: Double check the encounter note to see which provider performed the neurofunctional testing. A parenthetical note under 70555 instructs you to report the fMRI code with 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report) since a physician or other qualified healthcare professional may administer the neurofunctional test.

If a physician or psychologist is not administering the neurofunctional testing, then you’ll report only 70554. The parenthetical note under 70554 informs you that 70554 and 96020 cannot be reported together.