Radiology Coding Alert

Question: What is the correct MRI CPT Code for fiducial placement for brain tumor localization on a patient before surgery? It seems as though 70551 and 70552 are overcoding for this procedure. What do you think about 76393? 

Colorado Subscriber

Answer: Fiducial marker placement doesn't have its own code and may even be considered a bundled procedure by some payers.
 
Code 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation) is a good choice for this situation. Remember to append modifier -26 (Professional component) if the physician performs this service in a hospital and does not own the equipment. You may want to send the operative notes to explain the procedure.
 
Because the service is unlisted, consider reporting 76498 (Unlisted magnetic resonance procedure [e.g., diagnostic, interventional]) instead, along with the appropriate documentation.
 
If your physician performs a diagnostic MRI of the brain including the brain stem, your payer may accept codes 70551 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material) or 70552 (... with contrast material[s]). If this isn't quite accurate, consider reporting modifier -52 (Reduced services) along with an explanation of what your reimbursement should be and why.
 
Here's a tip if your physician is providing the markers: Considering there is no code for the markers, try 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies or materials provided]). Many payers, including Medicare, don't pay for this code, so get a waiver from the patient acknowledging he'll pay if need be. You should also see if your payer will accept HCPCS code A4649 (Surgical supply; miscellaneous).
 
But remember: If the seeds are supplied by the hospital, they are considered supplies and are not separately reimbursed.

 - The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.; and Gary S. Dorfman, MD, FACR, FSIR.