Radiology Coding Alert

Question: How should I report an MRI of the pelvis and abdomen, with and without contrast, for evaluation of a renal tumor, if the documentation notes "5-minute delayed" coronals?

Kentucky Subscriber

Answer: You should report the abdominal MRI with 74183 (Magnetic resonance [e.g., proton] imaging, abdomen; without contrast material[s], followed by with contrast materials[s] and further sequences).

For the pelvic MRI, assign 72197 (Magnetic resonance [e.g., proton] imaging, pelvis; without contrast material[s], followed by contrast material[s] and further sequences).

You should not report a separate code for the delayed coronal imaging.

Contrast note: The provider may need to inject contrast only once to get both the MRI of the pelvis with contrast and the MRI of the abdomen with contrast, but you can still report both as "with contrast."

ICD-9: Your diagnosis code will depend on the documentation. If the patient has a confirmed primary malignant neoplasm of the kidney, for example, you'd choose the appropriate code from 189.x (Malignant neoplasm of kidney and other and unspecified urinary organs). But if the documentation mentions only a "renal mass," consider whether 593.9 (Unspecified disorder of kidney and ureter) or 793.5 (Nonspecific abnormal findings on radiological and other examination of body structure; genitourinary organs) would be appropriate.