Neurology & Pain Management Coding Alert

Question: How is an MRA of the cranium coded?

California Subscriber

Answer: The new codes in CPT 2001 are 70544 (magnetic resonance angiography, head; without contrast material[s]), 70545 (... with contrast material[s]) and 70546 (... without contrast material[s], followed by contrast material[s] and further sequences). Coders should select the appropriate code based on the use of contrast.

MRA is a noninvasive diagnostic procedure that has been used for many years to evaluate the blood flow in internal carotid vessels in the head and neck, including the circle of Willis; the anterior, middle or posterior cerebral arteries; the vertebral or basilar arteries; and the venous sinuses. The procedure is performed on patients with conditions of the head and neck for which surgery is anticipated, including tumors, aneurysms, vascular malformations, vascular occlusions or thrombosis.

Although MRA is gaining acceptance by payers throughout the country, reimbursement policies are narrowly defined, and coding professionals must keep abreast of limitations and restrictions placed on its use by local Medicare carriers.

Common conditions in which MRAs are ordered include suspected nonruptured intracranial aneurysms (i.e., 437.3 cerebral aneurysm, nonruptured), arteriovenous malformations or AVM (i.e., 447.0 arteriovenous fistula, acquired) and carotid stenosis (433.10 carotid stenosis, without mention of cerebral infarction).

Answered by Scott Roberson, CPC, CPC-H, APC, senior compliance coding consultant at Intermountain Health Care, a multispecialty practice in Salt Lake City.