MR Brain/Iacs

sunshine · Joined: 15 Apr 2008 Posts: 1

Hi

Im new to radiology. I am only in the collections aspect and I am not a coder. I came across an acount today and the dr ordered an mr brain w/wo contrast. It was charged in our system as:
70553
70553-59

Is this correct? The report from the radiologist states:
MR Brain/IACS w/wo contrast.

Can you bill the same code twice since it is Brain/IACS to indicate that 2 areas were looked at?

Thanks so much!

sbuck · Joined: 22 Apr 2008 Posts: 7 Location: Stuart, FL

Hi there!

The Spring 2006 issues of Clinical Examples in Radiology published by the AMA/ACR addressed this issue:

MRI of the brain with particular attention being paid to the IACs is appropriately reported by CPT code 70553, Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences. In this study, an MRI of the brain was performed with targeted sequences to evaluate the IACs. The limited imaging of the pituitary glands, orbits, maxillary sinus, or IACs that is performed as part of a brain study is not coded separately as it was not performed as a separate and distinct dedicated study. Such body parts usually receive routine evaluation, to a limited extent, on a brain MRI examination. Additional sequences performed through such contiguous structures are a part of the base procedure code and are not reported separately.

Only in the rare circumstance when a complete MRI of the brain and a separate and complete MRI of the IACs are both medically necessary, ordered, and performed, would it be appropriate to report for two MRI brain studies. Such might be the case when a patient undergoes one study and then, because of some sudden change in clinical status, a second study is requested on the same date of service. When two MRI brain codes are reponed, modifier 59 is appended to the second MRI brain code to indicate that separate and distinct services were performed. In such rare circumstances radiologists should properly document the individual studies and medical necessity for each study.
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Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, CIC
Vice President, Southeast Radiology Management
"Your Radiology Business Experts"
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