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Radiology Coding Alert

Reader Questions:

Stand Up for MRI Payment?

Published on Mon Mar 27, 2006

Question: I code for stand-up MRI centers that can scan patients in different positions, such as flexion (bending forward) and extension (bending backward). Some payers reimburse for 76498 (Unlisted magnetic resonance procedure [e.g., diagnostic, interventional]), but others won't accept the code even when I send in additional documentation. Is there another code that will convince payers to reimburse for these additional sequences?


New York Subscriber
 

Answer: Code MRIs according to the body area that is being examined. There are no separate codes for standing, sitting, flexion, or extension scans.

Cigna considers stand-up MRIs experimental (www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0170_coveragepositioncriteria_standing_magnetic_resonance_imaging_vert_or_pos_mri.pdf).

Aetna "considers 'standing' MRIs (e.g., Stand-Up MRI) and 'sitting' MRIs (Position MRI or pMRI) to be not medically necessary because they have not been demonstrated to provide any advantage over conventional (supine) MRIs" (www.aetna.com/cpb/data/CPBA0093.html).

If the report indicates that the scan used significantly more time and resources than a supine scan, you can try adding modifier 22 (Unusual procedural services), but most payers will not provide additional reimbursement.

Stand-up (or upright) MRI allows providers to image the patient in more positions, including the position in which the patient experiences pain, proponents of the technology say.

But before your practice invests in this or other new technology, you should investigate payer policy and factor it into your business plan. Obtain written policy statements from your major payers stating whether you may bill the patient directly for additional services the payer won't cover or considers medically unnecessary.

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