Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 20, 2005 PDF

Do you know why 72195-72197 is a choice that will cost you?

The hip joint can cause coding confusion when you’re seeing double. If your documentation reveals a bilateral MRI of the hips, your modifier choice could be the difference between payment and denial.

Important: Medicare seems  to prefer that you report the MRI code with LT (Left side) and RT (Right side), says Rhonda Jay, quality assurance specialist for Southwest Diagnostic Imaging in Dallas. Texas Medicare has even suggested using LT and RT with 76 (Repeat procedure by same physician), she adds.

Example: The orthopedist reviews bilateral hip MRIs performed with contrast that a staff member administered using your practice’s own equipment. In this situation, you should report 73722-LT (... with contrast material[s]), 73722-76-RT.

Other payors prefer that you use modifier 50 (Bilateral procedure) “to keep it simple,” Jay says.

Check with your carrier:

Medicare recognized all joint MRI exams as eligible for bilateral   payment as of Jan. 1, 2004, so securing reimbursement for this service should not be a problem--as long as you code according to your carrier.

Some payors require you to report the CPT code twice, appending 50 to the second code, while for others, you will report the code once and append 50 to indicate a bilateral procedure.

Bottom line: Codes 73721-73723 represent unilateral studies--the July 2001 CPT Assistant reminds coders that to report bilateral studies you need to check your payor policies to determine the correct modifier to indicate two studies.

Pelvis pitfall: When coding for bilateral hip MRIs, don’t be tempted to report an MRI of the pelvis (72195-72197, Magnetic resonance [e.g., proton] imaging, pelvis ...).

The CPT codes for a pelvis MRI are not joint codes, explains Sandi Scott, CPC, PMCC, instructor and director of audit and training for InSight Health Corp. in Lake Forest, CA. So when the order is for a hip MRI, only use the lower-extremity joint codes 73721-73723, she says.