Radiology Coding Alert

Question: We have a radiology report that indicates the provider performed a fetal MRI on a pregnant patient. The patient was in her second trimester and was pregnant with one fetus. We assigned 72197 for the procedure, but the claim was denied.

How do we correct the claim?

Wisconsin Subscriber

Answer: You can correct the claim by changing the CPT^® code for the fetal magnetic resonance imaging (MRI) exam. You’ll assign 74712 (Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation) to report the fetal MRI.

Code 72197 (Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences), as well as 72195-72196 (Magnetic resonance (eg, proton) imaging, pelvis …), are designated for MRI exams of the patient’s pelvis. When you review 72195-72197 in the CPT^® code set, you’ll also find a parenthetical note listed under the codes directing you to 74712 and +74713 (… each additional gestation (List separately in addition to code for primary procedure)) for fetal MRI procedures.

A provider performs a fetal MRI to examine the developing fetus and evaluate any abnormalities in the unborn baby. The provider can examine the fetus’s organs, other tissues, and may include imaging of the maternal pelvis and placenta.