Radiology Coding Alert

Question: A patient arrives for a brain MRI without contrast. The radiologist sees something on the images and performs a brain MRI with contrast on the same day. Should I report this as two studies or as a without-and-with-contrast MRI?

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Answer: You probably won't find a black-and-white answer to this question, but because the services are on the same date of service, many experts recommend using 70553 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material, followed by contrast material[s] and further sequences).

Reason: A CCI edit bundles the noncontrast study (70551, ... without contrast material) into the contrast exam (70552, ... with contrast material[s]) when you perform both on the same day. You can override the edit with a modifier, but most payers will be reluctant to reimburse you for both exams. You can expedite your payment by billing for a single without-and-with-contrast exam (70553).

Orders: Before you code, you should also be sure you meet the test order requirements spelled out in Medicare Benefit Policy transmittal 80, dated Jan. 11, 2008 (http://www.cms.hhs.gov/Transmittals/Downloads/R80BP.pdf). Note that these requirements don't apply to radiologists in a hospital setting.

Example: If you're coding for a testing facility, and you have an order only for a diagnostic MRI without contrast, you need to get an order from the treating physician for the MRI with contrast.

You may perform and report the second test without an order only if you can't reach the treating physician, and you meet several criteria spelled out in the transmittal (such as, delay would harm the patient).

In a hospital setting, the hospital may grant the radiologist the ability to order new tests (42 CFR section 482.26). But some fiscal intermediaries may still deny claims unless you have an order from the treating physician.

Contrast: Remember that Medicare now allows you to report contrast (typically Q9951-Q9954) with MRIs (Medicare Claims Processing Manual, transmittal 1339, http://www.cms.hhs.gov/Transmittals/downloads/R1339CP.pdf).

-- 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.