Radiology Coding Alert
Don’t Go to Extremes Coding Upper Extremity MRIs
Review the guidelines to know which contrast administration counts. Radiologists use magnetic resonance imaging (MRI) to examine a patient’s upper extremities — their arms, hands, elbows, or wrists — for several different conditions. As a coder, you need to be well versed in these procedures, so you can ensure your providers receive proper reimbursement for their services. Read on to understand how to separate joint from non-joint extremity MRI codes and what is needed to report each code. Learn What is Meant By ‘Extremity’ An extremity is an upper or lower limb of the body, which also includes the hands and feet. Healthcare providers will use MRI to examine the tissues, bones, or joints of the extremities to evaluate for several reasons. These reasons include, but are not limited to: MRIs allow providers to visualize structures within the body in greater detail than X-rays and computed tomography (CT) scans. They create a detailed cross-sectional image of the patient’s internal organs and structures that the provider can examine to determine the patient’s condition. The CPT® code set features several codes for extremity MRI examinations, separated by upper and lower extremities. Locate the Upper Extremity MRI Codes Under the Upper Extremities section of the CPT® code set Radiology chapter, you’ll find codes dedicated to MRI exams for the arms and hands as well as upper extremity joints, such as the elbow and wrist. You’ll assign one of the following codes when the radiologist performs an MRI of the patient’s arm or hand: Example: A radiologist performs an MRI with contrast on a patient’s upper arm to evaluate an abnormality. After the procedure, the provider reviews the images and documents a diagnosis of a malignancy in the humerus. In this case, you’ll assign 73219 to report the MRI with contrast procedure. However, if the radiologist performs an MRI to examine the patient’s wrist or elbow, you’ll assign one of the following codes: Example: A patient is referred to an outpatient radiology practice for an MRI with contrast of their left wrist. The patient suffered a wrist injury while boxing at the local gym. The radiologist performed the procedure and examined the images. After reviewing the results, the provider diagnosed the patient with a torn extensor carpi ulnaris (ECU) tendon. Since the provider performed the MRI on the patient’s joint, you’ll assign 73222 to report the procedure. Look for Use of Contrast in the Documentation “Aside from verifying the correct CPT® code set is being utilized based on the anatomic area being imaged, another challenge or common mistake to be aware of when reporting extremity MRI codes is verifying whether contrast has been administered,” says Taylor Berrena, COC, CPC, CPCO, CPB, CPMA, CPPM, CRC, CEMC, CFPC, CHONC, coder III at MD Anderson Cancer Center at Cooper in Yorktown, Virginia. Each of the extremity MRI code descriptors listed above feature “without contrast material(s),” “with contrast material(s),” or “without contrast material(s), followed by contrast material(s) and further sequences.” These entries allow you to easily locate the correct code for the procedure performed. Remember: Just because the provider’s documentation indicates “with contrast,” the contrast material administered may not count toward a “with contrast MRI” procedure. According to the CPT® guidelines, “with contrast” only applies when contrast material is “administered intravascularly, intra-articularly, or intrathecally.” Oral and rectal contrast administration don’t count toward “with contrast” procedures, which means if the provider uses either of those contrast materials, then you’ll assign a “without contrast” extremity MRI code. Know When to Modify Your Extremity MRI Code Reporting Most radiology procedures listed in the CPT® code set feature a professional component and a technical component. When combined together, the two components form the global service. However, at times, radiologists will perform one component or the other of a given procedure. When this happens, you’ll need to append an applicable modifier to your procedure code. You’ll append modifier 26 (Professional component) when the healthcare provider performs the non-technical portion of the service. This typically includes interpreting the examination images and preparing the written report. On the other hand, you’ll append modifier TC (Technical component …) to your assigned code if the radiologist performs the technical portion of the service. The technical component involves setting up and using the equipment to capture images of the patient’s body structures, as well as any contrast administration. Examine This Extremity MRI Scenario Now you can put your extremity MRI coding knowledge into practice by reviewing the situation below and determining which CPT® codes to use. Scenario: A 26-year-old patient is referred to an outpatient radiology practice for an MRI after experiencing a sudden, sharp pain in the left elbow while pitching in a baseball game. The radiologist performed an elbow MRI without contrast, and then administered contrast material intra-articularly and captured additional images. After reviewing the images, the radiologist issued their findings of a rupture of the left ulnar collateral ligament (UCL). For this scenario, you’ll assign 73223 to report the radiologist’s services as the provider performed an MRI of the patient’s elbow without and with contrast to better visualize the UCL structure.
Radiology Coding Alert
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Don’t Go to Extremes Coding Upper Extremity MRIs
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