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-   -   same-day MRI/MRA head (http://www.aapc.com/memberarea/forums/showthread.php?t=31081)

jewelrad 02-18-2010 01:17 AM

same-day MRI/MRA head
 
how do you bill for MRI/MRA head done on same-day?
the physician ordered MRI&MRA of head for the medicare patient. the patient encountered once and MRI&MRA are done.
we should report this service with 70551(MRI head) and 70544(MRA head) with modifier 59 to receive payment on both MRI and MRA head according to the CCI Edits.
how do you manage same-day MRI/MRA head in your practice?

AuntJoyce 02-18-2010 09:05 AM

Same Day MRI/MRA
 
Good morning,

Indeed, you will bill it exactly as you have stated with the -59 modifier appended to the 70544.

Beware, you will more than likely have to appeal this on paper since many carriers automatically deny the second study (incorrectly).

I worked for a Radiology billing company for quite some time and this was the main denial set. After a while, when we first submitted these charges, we automatically made the copies so that we would not have to track it down later on. As soon as the denial hit, we popped a stamp on the envelope and off it went.

Good luck!

Joyce

krishna.k 02-20-2010 04:05 AM

Hi,

Please see below also this will help for you.
MRI/MRA Head
code pair 70544-59 70551
code pair 70544-59 70552
code pair 70544-59 70553
code pair 70545-59 70551
code pair 70545-59 70552
code pair 70545-59 70553
code pair 70546 70551-59
code pair 70546 70552-59
code pair 70546-59 70553

Thanks,
KrishnaCPC

Lizz B 03-02-2010 11:23 AM

MRI with MRA
 
What are the requirements for billing both MRI and MRA done during same session? (I code OP ancillary services at an acute care facility). My CT/MR Coder reference states only that it is appropriate to bill for both, assuming full and complete studies of each are performed, and yet when billed at the same time, our editing software kicks them out for CCI edits. I understand that I may add modifier 59, but WHEN is it appropriate to do so? If the radiologist gives a complete report on the MRI and then under 'MRA' notes 'no acute findings', 'negative study', or 'see above', am I justified in billing for both?

Any help would be greatly appreciated, along with a suggestion of reference sources for such things!

Thanks much!

ghiocel 03-07-2010 04:10 PM

mri/mra denial
 
I have the same situation, Medicare dined MRI of the brain and MRA of the head,done on the same session, stating modifier missing or invalid. What should I do in this case?I have two report done, one for MRI of the head and MRA of the head.

lornyllm 10-17-2010 10:12 PM

mri/mra done on the same day
 
Has anyone even gotten paid by medicare when they append the mra with modifier 59? I work for a radiology company and we have the same problems with medicare and some of the private insurances denying the second study as cannot be performed on the same day. Anyone have any thoughts or suggestion how to handle this issue. Most of our referring doctors would rather have the study done the same day and not have to bring the patients back.

jpproctor 10-19-2010 08:16 AM

Quote:

Originally Posted by AuntJoyce (Post 96770)
Good morning,

Indeed, you will bill it exactly as you have stated with the -59 modifier appended to the 70544.

Beware, you will more than likely have to appeal this on paper since many carriers automatically deny the second study (incorrectly).

I worked for a Radiology billing company for quite some time and this was the main denial set. After a while, when we first submitted these charges, we automatically made the copies so that we would not have to track it down later on. As soon as the denial hit, we popped a stamp on the envelope and off it went.

Good luck!

Joyce

If CMS normally considers the MRA part of the MRI when performed during the same session, and we break it down to bill separately by adding modifier 59 to the MRA, what specifically does our documentation need to note to justify the split? Any help is appreciated.

jgf-CPC 10-19-2010 10:32 AM

Mra
 
According to CMS it is appropriate to append the 59 mod to the 70544. There are times when we do have to appeal but normally get paid eventually.

jpproctor 10-19-2010 01:02 PM

Quote:

Originally Posted by jgf-CPC (Post 131342)
According to CMS it is appropriate to append the 59 mod to the 70544. There are times when we do have to appeal but normally get paid eventually.

Thank you Jackie. I guess my main concern is my documentation. What do I use to appeal? (Can't help but wonder why the codes were combined in the first place if we are allowed to bill 70544 w/mod 59 if done at the same time as the MRI. Seems counterproductive.) Also wondering if this same approach can be used for all the other codes that are now combined such as the CT/CTA, CT Orbits/CT Brain, Ultrasound/Vascular. It's easy to do this when these exams are done at different times of the day, but when done in the same session, we are unclear how they can fall within the guidelines of the correct usage of modifier 59 and stand up to an audit and can find nothing written to help my staff & me understand. Thanks for your help.

jpproctor 10-20-2010 04:25 PM

Quote:

Originally Posted by jpproctor (Post 131390)
Thank you Jackie. I guess my main concern is my documentation. What do I use to appeal? (Can't help but wonder why the codes were combined in the first place if we are allowed to bill 70544 w/mod 59 if done at the same time as the MRI. Seems counterproductive.) Also wondering if this same approach can be used for all the other codes that are now combined such as the CT/CTA, CT Orbits/CT Brain, Ultrasound/Vascular. It's easy to do this when these exams are done at different times of the day, but when done in the same session, we are unclear how they can fall within the guidelines of the correct usage of modifier 59 and stand up to an audit and can find nothing written to help my staff & me understand. Thanks for your help.

Found the answer to my questions regarding documentation on the ACR website and wanted to share:

"Question: Is it appropriate to report an MRI brain code for the axial images acquired as part of an MRA study? If not, when is it appropriate to report both brain MRI and brain MRA codes?

No, it is not appropriate to report a magnetic resonance imaging (MRI) brain code for the axial source images acquired as part of a magnetic resonance angiography (MRA) study. The axial source images are an integral portion of the MRA examination. While some lesions may be visible on the MRA axial source images, these images are specifically designed to minimize brain parenchymal resolution in order to optimize visualization of the vasculature.

Only when a full and complete brain MRI is performed separate from a full and complete MRA examination (separate data set acquisition) would it be appropriate to report both an MRI and MRA code. When medically necessary, MRI and MRA exams can be complementary. MRI and MRA of the brain represent separate procedures, each with a distinct anatomic target - the nervous system (extra-vascular) and its vascular system (intra-vascular). The two procedures employ distinctly different imaging protocols, and separate reports are generated. In this instance, the use of modifier 59 is appropriate, even though the distinct anatomic targets are both intracranial in location. As noted in the AMA’s Coding with Modifiers guide, in order to use modifier 59, documentation needs to be specific to the distinct procedure or service and be clearly identified in the medical record."
Thanks to all who helped with this one, it's much appreciated.


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