Cardiology Coding Alert

Question: Do the new rules on coverage for MRI with pacemaker affect coding?

New Jersey Subscriber

Answer: Yes. Medicare has released instructions via MLN Matters MM7441 on how to code MRIs for patients with implanted pacemakers. Remember that the pacemaker must be used according to FDA-approved labeling for MRI scans. (For now, stay alert for the Revo MRI SureScan Pacing System, labeled as MR Conditional. That means patients with the device implanted can undergo an MRI scan if certain conditions are met.)

For dates of service July 7, 2011, or after, you should report:

• The relevant MRI code
• Modifier KX, Requirements specified in the medical policy have been met
• V45.01, Cardiac pacemaker in situ.

Don't forget to report the appropriate ICD-9 code(s) for any findings or for the symptoms prompting the test if the physician documents no confirmed findings.

Your coding will differ if you're reporting MRI for patients with an implanted pacemaker or implantable cardioverter defibrillator in a Medicare-approved clinical study (date of service Feb. 24, 2011, or later). For those claims, you should report:

• The relevant MRI code
• Modifier Q0, Investigational clinical service provided in a clinical research study that is in an approved clinical research study
• V70.7, Examination of participant in clinical trial
• Either V45.02 (Automatic implantable cardiac defibrillator in situ) or V45.01, depending on which device the patient has.

MM7441 is online at www.cms.gov/MLNMattersArticles/downloads/MM7441.pdf.