Radiology Coding Alert

Question: How do we code for MRI of the brain with and without contrast with pituitary protocol which reads as follows:

Axial: T1 spin echo
Coronal: Pituitary specific T1, T1 Dynamic contrast enhanced and T1 delayed post gadolinium
Sagittal: Pituitary specific T1, T1 Dynamic contrast enhanced

New York Subscriber

Answer: You report code 70553 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material, followed by contrast material[s] and further sequences) for the MRI of the brain without contrast followed by MRI with contrast administration and for further pituitary protocol and its sequences. You report code 70553 only once. This code covers the service for MRI both without and then with contrast performed in a single MRI service session. Modifier selection would be based on whether you would bill for professional (modifier 26) or technical component (modifier TC) of the service.

If MRI brain and MRI pituitary are separately ordered and performed with a full series of sequences specifically of the pituitary gland, then you can consider reporting code 70553 twice with modifier 59 (Distinct procedural service) appended to the second code. However, you need to document clear, separate, and distinct indications for the two studies. With the separate documentation for MRI of brain and MRI pituitary, the second study can also be represented by 70553. When you report two codes, you exclude the possibility of reporting modifier 22 (Increased procedural services).

If both MRIs are performed by the same health care professional, then you can append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the second MRI instead of modifier 59.