Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Interventional Radiology
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 02-18-2010, 01:17 AM
jewelrad jewelrad is offline
Contributor
 
Join Date: Apr 2007
Posts: 22
jewelrad is on a distinguished road
Default 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?
Reply With Quote
  #2  
Old 02-18-2010, 09:05 AM
AuntJoyce AuntJoyce is offline
Guru
 
Join Date: Apr 2007
Posts: 170
AuntJoyce is on a distinguished road
Thumbs up 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
Reply With Quote
  #3  
Old 02-20-2010, 04:05 AM
krishna.k krishna.k is offline
Contributor
 
Join Date: Apr 2007
Posts: 11
krishna.k is on a distinguished road
Default

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
Reply With Quote
  #4  
Old 03-02-2010, 11:23 AM
Lizz B Lizz B is offline
Contributor
 
Join Date: Apr 2007
Posts: 24
Lizz B is on a distinguished road
Question 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!
Reply With Quote
  #5  
Old 03-07-2010, 04:10 PM
ghiocel ghiocel is offline
New
 
Join Date: Apr 2007
Posts: 1
ghiocel is on a distinguished road
Default 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.

Last edited by ghiocel; 03-07-2010 at 04:13 PM.
Reply With Quote
  #6  
Old 10-17-2010, 10:12 PM
lornyllm lornyllm is offline
New
 
Join Date: Apr 2007
Location: culver city, california
Posts: 5
lornyllm is on a distinguished road
Default 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.
Reply With Quote
  #7  
Old 10-19-2010, 08:16 AM
jpproctor jpproctor is offline
New
 
Join Date: Apr 2007
Posts: 3
jpproctor is on a distinguished road
Default

Quote:
Originally Posted by AuntJoyce View Post
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.
Reply With Quote
  #8  
Old 10-19-2010, 10:32 AM
jgf-CPC's Avatar
jgf-CPC jgf-CPC is offline
True Blue
 
Join Date: Apr 2007
Location: Columbus GA
Posts: 570
jgf-CPC is on a distinguished road
Default 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.
__________________
Jackie, CPC

Choose a job you love, and you will never have to work a day in your life. ~Confucius~
Reply With Quote
  #9  
Old 10-19-2010, 01:02 PM
jpproctor jpproctor is offline
New
 
Join Date: Apr 2007
Posts: 3
jpproctor is on a distinguished road
Default

Quote:
Originally Posted by jgf-CPC View Post
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.
Reply With Quote
  #10  
Old 10-20-2010, 04:25 PM
jpproctor jpproctor is offline
New
 
Join Date: Apr 2007
Posts: 3
jpproctor is on a distinguished road
Default

Quote:
Originally Posted by jpproctor View Post
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.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 08:28 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC