Radiology Coding Alert

Question: Should we report 0159T for MRI CAD that doesn't include pharmacokinetic analysis?

Connecticut Subscriber

Answer: You aren't the only one asking this question, and you may hear more than one answer regarding +0159T (Computer aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI).

According to the American College of Radiology (ACR), which submitted the request for the code to the AMA for publication, the answer is that you should report the code for all breast MRI CAD services -- not just those with pharmacokinetic analysis -- because that's how the ACR intended it.

CPT says: According to the AMA's CPT 2007 Changes, "add-on code 0159T was established to report magnetic resonance imaging (MRI) pharmacokinetic analysis." The example CPT 2007 Changes offers specifies that "the service includes the time for the clinical staff ... to initiate the pharmacokinetic analysis," among other items.

Comparing old and new: Before CPT introduced this code in July 2006, you reported the service with the following:

• 76377 -- 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation

• 76350 -- Subtraction in conjunction with contrast studies.

You reported the above with breast MRI codes, currently 77058 (Magnetic resonance imaging, breast, without and/or with contrast material[s]; unilateral) and 77059 (... bilateral), which typically added up to $125.

In contrast, 0159T has no RVUs, and payers deny payment for the code. But remember that reporting the code will help show the AMA that 0159T deserves permanent, payable Category I status.

Payers tend to fall inline with the ACR's stance that you should report 0159T even if your system doesn't perform pharmacokinetic analysis.

Real world example: A Florida women's center that uses a system without pharmacokinetic analysis submitted breast MRI CAD claims using 76377 and 76350. Blue Cross and Blue Shield of Florida demanded a refund of all image reconstruction and 3D payments (retroactive to October 2004, before 0159T even went into effect) because BCBS believed the center used the codes improperly, according to AuntMinnie.com.

-- The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.