Report MRI x 2 for Separate Brain, Pituitary Studies

A Coding Edge reader asks the following question:

When magnetic resonance imaging (MRI) of the brain and pituitary are done on the same day (without and with contrast), should we report multiple units of 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences with modifier 59 Distinct procedural service on the second unit, or should we report 70553 and 70543 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences?

Neither CPT® nor the Centers for Medicare & Medicaid Services (CMS) address this issue directly, but the American College of Radiology (ACR) has offered advice in its “Coding Q and A,” as follows:

Q:                  How should a study of an MRI of the brain and of the pituitary gland be reported?

A:                  If both an MRI of the brain and an MRI of the pituitary gland are separately requested and performed with a full series of specialized pulse sequences, specifically of the pituitary gland, then an MRI of the brain should be reported two times with a modifier (e.g. 59) appended to the second study. Note that clear, separate and distinct indications for two complete studies must be documented. If just an additional pulse sequence or two focused on the pituitary gland are added to the MRI of the brain, the extra sequences would be considered part of the base study and an MRI of the brain would be reported only once.

This is similar to the reporting of an MRI of brain and the internal auditory canal. Reference the March/April 2003 feature article of the ACR Radiology Coding Source™ for further discussion.

In other words, if two distinct and medically necessary studies are performed of the brain and pituitary without and with contrast, you may report 70553 and 70553-59. Code 70543 is not appropriate to report MRI of the pituitary.

Reports from the field indicate that few third-party payers will recognize and reimburse for two brain MRIs (e.g., two units of 70553) during the same encounter, even if the studies are properly documented and medically necessary. Alternatively, some payers may allow you to report the brain MRI with modifier 22 Increased procedural service to describe the additional sequences (note that modifier 22 cannot be applied to hospital outpatient services). When in doubt, check with your payer for instructions in writing.

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