Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that a patient came to the office and received a functional brain magnetic resonance imaging (MRI). What is a functional MRI, and how should I code the service?

Alabama Subscriber

Answer: Functional MRIs (fMRI) coding requires some more information about the encounter. Go back and check the notes (or speak to the performing provider). If the test is run entirely by a nonphysician healthcare professional (i.e., not a physician or psychologist), you’ll report 70554 (Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/ or visual stimulation, not requiring physician or psychologist administration).

You should never report 70554 along with 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report).

If a physician/psychologist conducted the MRI, you’d choose 70555 (… requiring physician or psychologist administration of entire neurofunctional testing) instead. However, you’ll need to make sure that the services of 96020 were performed before you can code 70555. According to CPT^® 2021, “Do not report 70555 unless 96020 is performed.

fMRI breakdown: The major characteristic of a brain fMRI is stimulus introduction. “Functional MRI involves identification and mapping of stimulation of brain function,” according to CPT^® 2021.

For example, “in the simplest fMRI experiment a subject alternates between periods of doing a particular task and a control state; such as 30-second blocks looking at a visual stimulus alternating with 30-second blocks with eyes closed,” according to the UC San Diego School of Medicine.

Don’t use these: There are three more brain MRI codes in the same set: 70557 (Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation)); without contrast material; 70558 (… with contrast material(s)); and 70559 (… without contrast material(s), followed by contrast material(s) and further sequences). These are for brain MRIs performed during open intracranial surgery, which is not happening in the scenario you describe.