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same-day MRI/MRA head

  1. #11
    Default
    Medical Coding Books
    http://medicare.fcso.com/coverage_fi...lcd_search.asp

    This link will help you find any LCD (as long as there is one) about any CPT code you want to search for. Just put the CPT code in the box where it says procedure code and it will appear slight under the LCD ID box.

    Now to help you guys with the MRI and MRA. MRIs and MRAs are procedures that are essentially the same when describing the technical component of the study (Both are images, but MRIs are more specifically for soft tissue evaluation and MRAs for artery visualization with the use of contrast material). Therefore, since the procedures are similar to one another you need to add a modifier (-59) to the MRA studies in order to get paid because it is a separately identifiable procedure from the MRI procedure. Now remember that the referring doctors needs to document his medical necessity very accurately to avoid overpayment.

    Now for the CT Scans of the brain and orbits. These procedures are extremely similar because the CT Scan will catch traverse images of the brain and the orbits all together when the technician is performing the procedure. This leads to insurance companies calling it a duplicate because both parts are included in one study. One way to avoid this is just have the patient do the head scan in one day and come back another day and do the orbit scan. Remember that your doctors need to document correctly the medical necessity.

    Hope this helps, feel free to reply with any questions.
    Last edited by nelsong5; 10-23-2010 at 08:59 PM.

  2. #12
    Location
    Portland, Maine
    Posts
    19
    Default 59 or xu
    With the addition of the x modifiers would you bill this combination with a 59 still or an XU modifier instead ?

  3. #13
    Default
    The below information is directly from the NCCI manual


    CHAP9-CPTcodes70000-79999_final103115.doc
    Revision Date: 1/1/2016
    CHAPTER IX
    RADIOLOGY SERVICES
    CPT CODES 70000 - 79999
    FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES

    9. Computed tomography (CT) and computed tomographic angiography (CTA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate CT and CTA reports, only one procedure, either the CT or CTA, for the anatomic region may be reported. Both a CT and CTA may be reported for the same anatomic region if they are
    performed at separate patient encounters or if two separate and distinct technical studies, one for the CT and one for the CTA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon.
    Similarly magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate MRI and MRA reports, only one procedure, either the MRI or MRA, for the anatomic region may be reported. Both an MRI and MRA may be reported for the same anatomic region if they are performed at separate patient encounters or if two separate and distinct technical studies, one for the MRI and one for the MRA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon
    Last edited by chembree; 05-18-2016 at 02:50 PM.

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