Radiology Coding Alert

Make the most of modifiers for leg-joint imaging reports

You may be familiar with coding lower-body MRIs, but what happens when the radiologist images more than one joint? We'll show you how to breeze through selecting an accurate code and appending appropriate modifiers. Straightforward Coding for a Standard MRI Problem: You won't find "MRI; Hip" in your CPT Codes index. Instead: When the order is for a hip MRI, you should choose the proper code from 73721-73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity ...) because the hip is a joint, says Sandi Scott, CPC, PMCC instructor and director of audit and training for InSight Health Corp. in Lake Forest, Calif.

Keep an eye out for whether you need to designate which aspect of the MRI you're reporting, says Rhonda Jay, quality assurance specialist for Southwest Diagnostic Imaging in Dallas.

Append modifier 26 (Professional component) if you're coding only the radiologist's reading of the image, or append TC (Technical component) if you're reporting only the imaging itself. If you're part of an entity, such as a radiology office, that provides the interpretation and technical exam, report the global code without modifiers 26 or TC. Bolster Your Bilateral Hip MRI Coding If your documentation reveals a bilateral MRI of the hips (meaning imaging of both hips), your modifier choice could be the difference between payment and denial.

Some payers - especially Medicare - seem to prefer that you report the MRI code with LT (Left side) and RT (Right side), Jay says. Texas Medicare has even suggested using LT and RT with 76 (Repeat procedure by same physician), she adds. Example: The radiologist reviews bilateral hip MRIs performed on his own equipment with contrast. Report 73722-LT (... with contrast material[s]), 73722-RT-76.

Other payers prefer that you use modifier 50 (Bilateral procedure) "to keep it simple," Jay says.

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 payers require you to report the CPT Code twice, appending 50 to the second code, while for others, you should report the code once and append 50 to indicate a bilateral procedure.

Bottom line: Codes 73721-73723 represent unilateral studies - CPT Assistant (July 2001) tells you that to report bilateral studies you need to check your payer policies to determine the correct modifier to indicate two studies, says Rehna Burge, radiology coder at North Oaks Health System, a [...]