Radiology Coding Alert

Question: What CPT^® code should I report for a magnetic resonance imaging (MRI) scan of the breast with contrast?

New York Subscriber

Answer: If you are working on a claim with a 2018 date of service (DOS), then you will report 77058 (Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral) for a unilateral MRI and 77059 (Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral) for a bilateral MRI.

For a DOS of 2019, the answer gets a little more complicated. Depending on laterality, you’ll choose between 77048 (Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral) and 77049 (Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral).

However, as you can see, these codes do not include the same “without and/or with” phrasing as the 2018 codes. Additionally, you should only report codes 77046 (Magnetic resonance imaging, breast, without contrast material; unilateral) and 77047 (Magnetic resonance imaging, breast, without contrast material; bilateral) for non-contrast breast MRI services.

Since no respective guidance exists as to how to code a breast MRI with contrast in 2019 and beyond, it’s advised that you contact the payer before making any coding determinations. However, the most obvious solution is to report codes 77048 and 77049 with modifier 52 (Reduced Services). When doing so, you should send a paper claim in addition to an electronic claim (for timely filing). On the paper claim, you should include justification for the use of modifier 52 along with the dictation report for the MRI.