The rules we use:
Straightforward Coding for a Standard MRI
Problem: You won't find "MRI; Hip" in your CPT 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.
Keep an eye out for whether you need to designate which aspect of the MRI you're reporting.
When you need to code for bilateral hip MRIs, don't be tempted to report an MRI of the pelvis (72195-72197, Magnetic resonance [e.g., proton] imaging, pelvis ...). The CPT codes for a pelvis MRI are not joint codes. When the order is for a hip MRI, only use the lower- extremity joint codes 73721-73723.
Only use the MRI pelvis codes if the order is specifically for a pelvis MRI and/or the physician looks at the pelvic viscera, such as the organs and soft tissue.
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.
Medicare allows the RT and LT modifiers or the 50 for bilateral. Medicaid in most states does not allow any modifiers. Check with other carriers which modifier to use.
If you have an order for MRIs of both hips and the pelvis and written reports for all three services, you may claim all three. Experts warn: Before you code for multiple studies, be sure the documented clinical indications support them. You should also have full and complete exams of all the anatomic sites - not just one exam that superficially includes all of the sites - with complete reports for each coded exam.
When you have a question about the proper use of a CPT code, you'd be wise to check with your local carrier. If your carrier won't offer a specific answer, consider the descriptor and use your best judgment to decide the most ethical way to use the code, she adds. For 73721, for example, because the descriptor refers to "any joint" in the singular, you should feel comfortable reporting this code per joint and defending your choice in an audit.
Hope this explains it for you...it helped me a lot!
