Radiology Coding Alert

Question: Our radiologist documented visualizing the following vessels through MRA: infrarenal abdominal aorta, celiac artery, superior mesenteric artery, and the renal arteries. She also visualized both right and left of these vessels: common, internal and external iliacs, common femoral, superficial femoral, profunda, popliteal, tibioperoneal, anterior and posterior tibial, and peroneal. Which codes should I report, and which vessels are abdominal, pelvic and lower extremity?Texas SubscriberAnswer: For this session, you should report 74185 (Magnetic resonance angiography, abdomen, with or without contrast material[s]) and 73725 (Magnetic resonance angiography, lower extremity, with or without contrast material[s]).Watch out: When the radiologist documents MRA of the abdomen and both legs, you should not separately report a pelvic MRA (72198, Magnetic resonance angiography, pelvis, with or without contrast material[s]). Abdomen: If the radiologist had only documented the following MRA studies, you would report 74185 alone:• infrarenal abdominal aorta• celiac artery• superior mesenteric artery• renal arteries.Lower extremity: You would report 73725 alone if you have documentation of only right and left MRAs of the following arteries:• common femoral• superficial femoral• profunda• popliteal• tibioperoneal• anterior and posterior tibial• peroneal.Because these are both right and left MRAs, you will need to indicate this on your claim. Depending on your payer, you may report two units, append modifiers LT (Left side) and RT (Right side), or modifier 50 (Bilateral procedure).Pelvic: If the radiologist documented MRA of only the common, internal and external iliacs, you could report a pelvic MRA (72198).But remember that because the radiologist performed both abdominal and lower-extremity MRAs during the same session in your case, you should not report the pelvic MRA separately.Tip: Medicare often limits pelvic MRA coverage to urinary organ neoplasms (189.x, Malignant neoplasm of kidney and other and unspecified urinary organs) and iliac artery aneurysms (442.2, Other aneurysm; of iliac artery).