Pain Management Coding Alert

Testing:

Follow This FAQ for Lowdown on MRIs

Published on Tue Jul 10, 2018

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You need to consider anatomy, contrast material to nail these claims.

Coding for your PM specialist’s magnetic resonance imaging (MRI) services can be quite taxing. First, there’s a bunch of MRI codes spread throughout the Radiology section of the CPT^® book.

Also, there are a couple of questions involving contrast material that you’ll have to answer before you can choose the correct code.

Help’s here: Check out this FAQ with Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana, for all you need to know on coding MRIs.

Q: Why are there so many MRI CPT^® codes?

A: “MRIs are like any type of x-ray, so they are very specific to body areas and body systems,” explains Holle. “They create a detailed cross-sectional image of the patient’s internal organs and structures. Consequently, the number of CPT^® codes are extensive.”

For example, if the PM specialist performs an MRI on a patient’s upper extremity excluding the joint, there is a specific MRI code set for the procedure. That’s right, code set. For MRIs on a patient’s upper extremity that exclude the joint, choose from one of the following codes depending on encounter specifics:

73218 — Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)
73219 — … with contrast material(s)
73220 — … without contrast material(s), followed by contrast material(s) and further sequences.

Q: What conditions might a patient suffer from when they require an MRI?

A: According to Holle, patients that present with severe headache may have an MRI to determine if they are having a brain aneurysm or possibly have a brain tumor. Your provider might choose from these MRI types for a patient with severe headache:

70551 — Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material
70552 — … with contrast material(s)
70553 — … without contrast material, followed by contrast material(s) and further sequences “Patients with injuries to the back could have [an MRI] to determine the extent of the back and spinal cord injury,” she continues.

So, if your PM specialist performs an MRI to screen the lumbar area of a patient’s spinal canal, you might choose from the following MRI codes:

72148 — Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material
72149 — … with contrast material(s)
72158 — Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar.

These are just examples, however. You could find yourself coding just about any MRI type in a PM clinic. Just be sure to pay attention to the notes, and choose the code that best represents your provider’s service.

Q: When will the provider use contrast for an MRI?

A: “Contrast is only used when there needs to be a better enhancement of body tissue. Patients with inflammations will more than likely have contrast ordered,” relays Holle.

Q: What is the difference between “with contrast material” (70552) and “without contrast material, followed by contrast material[s] and further sequences” (70553)?

A: “This simply means that the provider wants to see what the MRI shows what is visible without the contrast but may feel that there is a need for further detail in the tissue with the contrast,” says Holle.