Radiology Coding Alert

Magnetic resonance angiography (MRA) is a noninvasive diagnostic procedure slowly gaining acceptance by payers throughout the country. Nonetheless, reimbursement policies are narrowly defined and coding professionals must keep abreast of limitations and restrictions placed upon its use by local Medicare carriers.

It is especially important to note that approved uses of MRA differ, depending on the body site being imaged. For instance, Medicare approved the use of MRA for the chest and abdomen here in Wisconsin on July 1, 1999, says Bernadette Raasch, RTR, who works with the radiology department at the Medical College of Wisconsin. (MRA of the chest: CPT 71555 , magnetic resonance angiography, chest [excluding myocardium], with or without contrast material[s]; MRA of the abdomen: CPT 74185 , magnetic resonance angiography, abdomen, with or without contrast material[s]).

Prior to that, there were reimbursement policies in place only for MRAs of the head and neck and of the lower extremities. (MRA of the head and neck: 70541, magnetic resonance angiography, head and/or neck, with or without contrast material[s], MRA of the lower extremities: 73725, magnetic resonance angiography, lower extremity, with or without contrast material[s]).

Even with these recent policy changes, she adds, coders cant assume that MRA imaging will be approved in all situations. Here in Wisconsin, we have found that only a narrow window of diagnostic codes are acceptable for reimbursement, Raasch says. I strongly recommend that all coders read their states Medicare policy closely to find what they will allow.

Radiologists also must be aware that most carriers will not reimburse for both MRAs and the more traditional contrast angiography (CA) on the same patient, she notes. For instance, the Wisconsin Medicare policy states that only one of these tests will routinely be covered unless the physician can demonstrate the medical need to perform both.

MRA of the Chest CPT 71555

Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C., reports that an informal survey of local Medicare review policies (LMRPs) throughout the country indicates that reimbursement for MRAs of the chest is the most restrictive. In fact, she says, it has been approved in only two circumstances: for the diagnosis of pulmonary embolism (995.2, unspecified adverse effect of drug, medicinal and biological substance; and 414.1, aneurysm of heart or 415.11, iatrogenic pulmonary embolism and infarction) and for the evaluation of thoracic aortic dissection and aneurysm (441.2, thoracic aneurysm without mention of rupture; 441.7, thoracoabdominal aneurysm, without mention of rupture; 444.1, arterial embolism and thrombosis of thoracic aorta; and V67.0, follow-up examination; following surgery).

Furthermore, the restrictions for utilizing MRAs in cases of pulmonary embolism are especially limiting. The LMRPs studied indicate that MRA may be used only in patients who are [...]