MRI of the Brain/including IAC billing

Bemcg1957

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Would like input on this coding situation. I believe that the IAC's are viewed with the brain MRI, but the doc's would like both the orbit/neck mri billed w/59modifier, and the brain mri billed???????
 

kevbshields

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MRIs of IACs code to the 70540-70543 code set.

As for appending the -59 modifier, that would be dependent upon the payer, as some consider the two exams bundled.
 
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I came across the same issue recently. I resolved it by contacting the insurance and authorizing both studies. I made sure the radiologist read and reported both seperately, and billed for both. From what I unserstand as long as they are seperately reportable, they are payable. :)
 

tracross

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Re: MRI of the Brain/Including IAC Billing

This is a common problem I have because I bill for several radiologists practices. So I would agree that in order to get get paid (especially by Medicare) there must be 2 separate and distinct reports with different diagnosis.

However when it comes to using a modifier, you'll guess is as good as anyone's. At first I use to bill with modifier 59. After several appeals, I received a letter from PA Medicare stating to use modifier 76. When that was used, they still denied the claim. :confused:

If someone has any better suggestions, please help. tracross3@hotmail.com
 
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