Ob-Gyn Coding Alert

Question: What are the requirements for a fetal MRI?

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Answer: Your question is very broad as CPT^® does not indicate documentation requirements for this test. But you should note that the American College of Radiology (ACR) recommends that fetal MRI be deferred until after 20 weeks if possible. “This is in part because the fetus is so small at earlier gestational ages that MR is unlikely to add much additional information to ultrasound, but it is also because the effects of energy from the MR on the developing fetus are not completely understood. There is concern for the developing hearing structures in particular,” says Melanie Witt, RN, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Ultrasound: Some centers always perform a complete fetal ultrasound prior to MRI and use the findings as the basis for supporting performing the MR. The advantages are:

• detecting fetal demise before MR is performed;
• determining fetal lie in advance so that the coils can be positioned more precisely, especially if only a few MR sequences are be taken;
• the anatomic issues are well understood so that the MR can be appropriately set to target the areas of interest.
• For some centers, ultrasound first is not possible, and in this situation, it will be necessary to perform an ultrasound following the MR, or at least to have a report from recent ultrasonography to help verify fetal size and anatomy. “We will have to see if payers bundle the initial or subsequent fetal ultrasound on the same date of service,” Witt says.

But you should note, that CPT^® guidelines state that if only the placenta or maternal pelvic is imaged without doing fetal imaging, codes 72195, 72196 and 72197 which describe MRI of the pelvis, should be reported instead.