Radiology Coding Alert

Question: When magnetic resonance angiography (MRA) of the abdomen ( CPT 74185 ) is performed with a diagnosis of renal stenosis (440.1), will Medicare deny the MRA or should this be covered? What about managed care payers?

Anonymous TX Subscriber

Answer: The consensus among our experts is that Medicare will deny use of MRA of the abdomen for evaluation of renal stenosis (atherosclerosis of renal artery for 440.1). Remember that coverage does not equal payment. Even though Medicare recently expanded coverage of MRA to include the abdomen effective July 1, 1999, Medicare continues to view it as investigational and, therefore, subject to limited coverage. The problem for coders is finding out what Medicare (or any other third-party payer) accepts as appropriate medical indications (read ICD-9-CM codes) to justify medical necessity of an MRA of the abdomen. Based on experience with coverage of MRA of the head and neck and MRA of the lower extremities, it will take time and persistence to gain acceptance of a specific list of payable ICD-9 codes.

In the meantime, coders are advised to check with their local Medicare carrier for the latest in payable ICD-9-CM codes related to 74185 (MRA abdomen). Contact HCFA for a copy of the latest Program Memorandum (PM Transmittal No. AB-99-34, June 1999), Intermediary and Carrier Billing and Claims Processing Instructions for Magnetic Resonance Angiography. Finally, for those radiologists who are eager to use MRA in spite of likely denials, coders should inform the radiologists of Medicare and local third-party payer limits and enlist their help to expand the acceptable diagnoses based on current clinical standards for MRA.