Radiology Coding Alert

Question: A local neurosurgeon occasionally asks us to do a sagittal plane image of the spine on his patients since youve got them on the table anyway. For instance, if were doing an MR of the cervical spine, he may call us and ask for a sagittal MR of the thoracic spine. Should we code only the ordered exam, with a -22 modifier? Or would it be better to also report the additional thoracic MR study with modifier -52? I dont want to use an unlisted-procedure code.

New Jersey Subscriber
 
Answer: You cannot code and get paid for the second study under the circumstances described. Without a formal order from the requesting physician, supported by a medical condition justifying the additional exam, it would be inappropriate, even fraudulent, to report the additional imaging service. If the radiologist nonetheless complies with the neurosurgeons request, knowing that the services are not reimbursable, an unwanted, unwise and expensive precedent may be set.
 
The only solution is for the practice to contact the neurosurgeon and explain that it cannot conduct the study without an order and an appropriate diagnosis. Emphasize that the charges for the extra images cannot be submitted and that the radiology practice would be forced to absorb the costs, which it is unwilling to do.
 
None of the coding options described above would be appropriate. Without the order and a diagnosis, modifier -22 (unusual procedural services) added to the original study is unjustifiable. For the reasons noted, a second code appended with modifier -52 (reduced services) is equally incorrect. The practice should simply report the code that best describes the study ordered. These include 72141 (magnetic resonance [e.g., proton] imaging, spinal canal and contents, cervical; without contrast material), 72142 (... with contrast material[s]) or 72156 (... without contrast material followed by contrast material[s]).
 
If the neurosurgeon provided an appropriate order, a limited study could be reported by using the appropriate CPT code for the study performed with the -52 modifier appended to it.