Incomplete MRI Study


Monroe Township, NJ
Best answers
Is there any billing recourse for a Radiology facility when patients are unable to complete an MRI due to claustrophobia? I know there is a reduced services which you can use for surgery but if the MRI was actually started would that be appropriate or would it prevent the insurance company from paying for the test if it was accomplished at an open or stand up unit? We are experiencing 3-4 a week and with the lowered reimbursement, it is becoming a financial burden.
I think you might run into issues reporting 2 MRIs especially if it's one of those payers that require prior auth for advanced imaging.

Have you looked at the process prior to the patients being seen. Do they know you have an open MRI prior to arrival? Are these people who say they aren't claustrophobic and then after they are in they realize they are wrong?
We have prior authorizations for thee studies. At the present time we don't ask if the patient is claustrophobic because we don't want to create that thought in the patient's mind.
The code is not based on whether its an open MRI machine or not so the PA shouldn't cause any issues. Last time I had an MRI both my PCP and the place doing the scan asked if I was claustrophobic before scheduling it. They don't schedule it either until the PA is on file.
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