Radiology Coding Alert

Question: Is there a specific code for MRCP? We performed a scan on a patient with acute pancreatitis.

Mississippi Subscriber

Answer: Code S8037 (Magnetic resonance cholangiopancreato-graphy) is specific to MRCP, as the descriptor reveals, but you can't assume your payer will accept this code.

According to the HCPCS manual, Blue Cross/Blue Shield and the Health Insurance Association of America use S codes to report drugs, services, and supplies that have no national codes. Medicaid may also use these codes, but Medicare won't pay them.

MRCP looks at the liver, gall bladder, bile ducts, pancreas, and pancreatic duct. CPT® Assistant (July 2009) recommends reporting an MRI abdomen code as well as a 3D reconstruction code. The reasoning is that a typical "MRCP study includes a standard MR of the abdomen, along with MIP (maximum intensity projection) images to better delineate the bile duct anatomy," CPT® Assistant states. Final code choice depends on the services ordered, performed, and documented.

For the MRI abdomen, choose from the following, based on contrast use:

• 74181, Magnetic resonance (e.g., proton) imaging, abdomen; without contrast material(s)
• 74182, ... with contrast material(s)
• 74183, ... without contrast material(s), followed by with contrast material(s) and further sequences.

The 3D codes differ based on whether the provider performs postprocessing on an independent workstation:

• 76376, 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation
• 76377, ... requiring image postprocessing on an independent workstation.

Diagnosis: For acute pancreatitis, you should report 577.0 (Acute pancreatitis). When ICD-10-CM becomes effective, you'll have additional codes to choose from:

• B25.2, Cytomegaloviral pancreatitis
• K85.0, Idiopathic acute pancreatitis
• K85.1, Biliary acute pancreatitis
• K85.2, Alcohol induced acute pancreatitis
• K85.3, Drug induced acute pancreatitis
• K85.8, Other acute pancreatitis
• K85.9, Acute pancreatitis, unspecified.