Radiology Coding Alert

Find out which code the AMA suggests for pituitary MRIs

CPT offers you one set of MRI codes for orbit, face and/or neck and another for the brain and brain stem. Do you know which to choose for an internal auditory canal exam? Find out what the experts have to say.

1. Special Tests May Not Get Special Codes

Question: Does CPT offer codes other than 70551-70553 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem] ...) for diffusion tensor imaging?

Answer: No. You should stick to 70551-70553 for diffusion tensor imaging (DTI), which evaluates the direction and amount of water diffusion within the body, instructs Cheryl Schad, BA Ed, CPC, ACS-RA, PCS, owner of Schad Medical Management, in The Coding Institute audioconference, "Tackling Coding and Compliance Issues for CT/CTAs and MRI/MRAs" (http://www.audioeducator.com/industry_conference.php?id=940).

The same holds true for two other special brain MRI techniques, says Schad, who specializes in radiology coding:

• diffusion weighted imaging (DWI), which evaluates water diffusion within the body

• perfusion imaging, including perfusion weighted imaging, which evaluates microscopic blood flow levels.

2. Trust Brain Imaging Codes for IACs

Question: Which code should I report for an MRI of the internal auditory canals (IACs) without contrast material?

Answer: You should report IAC MRIs with 70551-70553. For an IAC MRI without contrast material, you should report 70551 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material).

Reason: Brain MRI codes 70551-70553 are appropriate because the inner ear and eighth nerve are part of the brain stem, Schad says, citing the AMA 2003 Coding Symposium.

Bonus: The AMA cited the same reasoning for instructing you to report 70551-70553 for pituitary studies.

3. Look to 70540-70543 for Brachial Plexus MRI

Question: What code should we report if we perform a brachial plexus MRI to the thyroid gland level to diagnose head and neck cancers?

Answer: You should choose the appropriate code from 70540-70543 (Magnetic resonance [e.g., proton] imaging, orbit, face and/or neck ...), according to the February 2001 ACR Bulletin, Schad says.

The American College of Radiology (ACR) maintains that you should use 70540-70543 for orbit, face and neck MRIs, but also "for reporting an MRI of the brachial plexus, when the study is performed to the level of the thyroid gland for diagnosing head and neck cancers," Schad says.

Remember: Although medical specialty societies offer a wealth of invaluable technical knowledge, their coding opinions are nonbinding, Schad says. If CMS or the AMA offers guidelines, those trump nonbinding opinions and are the standards an insurance audit holds providers to.

Tip: In 2007, CPT changed the descriptors for 70540-70543 from "and" to "and/or."

Reason: The "and" inaccurately suggested that you had to image all of the sites -- face, head and neck -- to report one of the codes, according to the AMA's CPT Changes 2007.

The "and/or" clarifies that you also may use the codes "if the patient has imaging performed on just the face, just the orbits or just the neck," explains Becki Garaud, CPC, CPC-E/M, RCC, compliance education and coding trainer with University of Washington Physicians and Children's University Medical Group.