Radiology Coding Alert

Question: Recently we have been getting denials when we submit claims for limited MRI studies of the brain on children. Weve used CPT 76499 because there does not seem to be a more specific choice. Is this correct?

Texas Subscriber  
Answer: There is no reason to use an unlisted procedure code (76499, unlisted diagnostic radiologic procedure) for an MRI of the brain on a child. There are no age parameters for the generally accepted codes, so the appropriate one may be assigned (i.e., 70551, magnetic resonance [e.g. proton] imaging, brain [including brain stem]; without contrast material; 70552, with contrast material[s]; or 70553, without contrast material, followed by contrast material[s] and further sequences).
 
If the MRI takes additional effort and time because working with the child is challenging, modifier -22 (unusual procedural services) may be appended. Conversely, if a lower level of service was offered, modifier -52 (reduced services) would be appropriate.