Radiology Coding Alert

Question: In a patient who reported for third nerve palsy, our physician did an MRA of the brain.  During this procedure, the examination of the arterial vasculature of the posterior fossa and Circle of Willis region was done. How can we report these services?

Codify Subscriber

Answer:  Check if your physician used contrast for magnetic resonance angiography of the head. Accordingly, you submit code 70544 (Magnetic resonance angiography, head; without contrast material[s]) or 70545 (Magnetic resonance angiography, head; with contrast material[s]). 

Check if your physician obtained a sequence of images. If your physician obtained initial images without contrast and then injected contrast and repeated the images, you submit code 70546 (Magnetic resonance angiography, head; without contrast material[s], followed by contrast material[s]) and further sequences).

Diagnosis coding: For third nerve palsy, you submit ICD-9 code 378.51 (Third or oculomotor nerve palsy partial). When ICD-10 is implemented later this year, you will need your physician to be specific for the laterality of the lesion. For third nerve palsy in the right, left, and both eyes, you have codes H49.01 (Third [oculomotor] nerve palsy, right eye), H49.02 (Third [oculomotor] nerve palsy, left eye), and H49.03 (Third [oculomotor] nerve palsy, bilateral), respectively. When your physician does not document the laterality, you submit code H49.00 (Third [oculomotor] nerve palsy, unspecified eye).