Neurology & Pain Management Coding Alert

Question: What is the proper code for an MRA of the cranium?

Nevada Subscriber Answer: CPT added new codes in 2001 to describe magnetic resonance angiograpy (MRA) of the cranium. These include 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). You should select the appropriate code depending on whether the ordering physician specifies the use of contrast materials.

Be sure you append modifier -26 (Professional component) for tests conducted on hospital or facility equipment. If the ordering physician owns the equipment on which the test occurs, you may report 70544/70545 with no modifiers attached.

Although MRA is gaining acceptance by payers throughout the country, the number of medically necessary diagnoses remains small. Common conditions in which MRAs are ordered include suspected nonruptured intracranial aneurysms (i.e., 437.3, Cerebral aneurysm, nonruptured), arteriovenous malformations (AVM) (i.e., 447.0, Arteriovenous fistula, acquired), and carotid stenosis (433.10, Carotid stenosis; without mention of cerebral infarction).