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cpt 70553 with a Modifier 22????

  1. #1
    Unhappy cpt 70553 with a Modifier 22????
    Medical Coding Books
    Hello, Radiology Coding Experts. I really need your advice.

    Doc is coding MRI Brain w/attn to Pituitary Gland and wants to use a modifier 22 because he states it is an extra test. Also he dictates a separate paragraph with the Attn to the Pituitary Gland and his findings on that.

    This is a separate paragraph on the same report as the MRI Brain w and without.

    My question is this. Is there any circumstances where a Mod 22 wound be a valid modifier to add to ANY diagnostic test for separately identifiable procedure? And if so, what would be an example of that circumstance?

    If the answer is no, and the mri brain with and without contract (CPT 70553) covers the exam of the pituitary gland. where can I find documentation to that effect to inform the doctor???? pLEASE HELP!


    Claudia K

  2. Default
    Per the ACR, if MRI brain and MRI pituitary are separately ordered and performed w/a full series of sequences specifically of the pituitary gland, then MRI brain CPT should be reported two times w/a mod 59 on the second study. There needs to be "clear, separate, and distinct" indications for the two studies. However, very few 3rd party payors will reimburse for two MRIs of the brain during same encounter. Some providers have chosen to report a single MRI w/mod 22, but 22 can not be used on hospital outpatient claims.

    This information is from the 2003 AMA CPT Coding Symposium and is stated in the CSI Navigator for Diagnostic Radiology 2008 edition.

    Hope that helps!

  3. #3
    Question mri brain w cpt 70553 and mod 22
    Thanks for the info. One question: IF this is being performed at a free standing radiology facility, it is outpatient, right? Are you saying in that instance that you cannot append mod 22???


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