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MRI of the Brain/including IAC billing

  1. Default MRI of the Brain/including IAC billing
    Medical Coding Books
    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???????

  2. #2
    Louisville, KY
    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.

  3. Default
    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.

  4. #4
    Default 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.

    If someone has any better suggestions, please help.
    Tracy CPC, Mt. Laurel, NJ

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