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Coding Corner: Get Hip to Lower-Extremity MRI Rules

Count on modifiers for leg-joint imaging reports

You may be familiar with coding lower-body MRIs, but what happens when the physician images more than one joint? Here鈥檚 how to breeze through selecting an accurate code and appending appropriate modifiers.
Use 73721 for Standard MRI
Problem: You won鈥檛 find 鈥淢RI; Hip鈥� in your CPT index. Instead: When the order is for a hip MRI, you should choose the proper code from 73721-73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity...) because the hip is a joint, says Sandi Scott, CPC, PMCC, instructor and director of audit and training for InSight Health Corp. in Lake Forest, Calif. Keep an eye out for whether you need to designate which aspect of the MRI you鈥檙e reporting, says Rhonda Jay, quality assurance specialist for Southwest Diagnostic Imaging in Dallas.
For some payers, you鈥檒l need to append modifier TC (Technical component) to show that you鈥檙e designating only the technical component, which uses hospital resources, such as equipment and staff time.
Bolster Your Bilateral Hip MRI Coding
If your documentation reveals a bilateral MRI of the hips (meaning imaging of both hips), your modifier choice could be the difference between receiving payment and getting a denial.
Some payers--especially Medicare--seem to prefer that you report the MRI code with LT (Left side) and RT (Right side), Jay says. Texas Medicare has even suggested using LT and RT with 76 (Repeat procedure by same physician), she adds. Example: The physician reviews bilateral hip MRIs with contrast. For this procedure, you鈥檒l report 73722-LT (... with contrast material[s]), 73722-RT-76. Note that other payers prefer that you use modifier 50 (Bilateral procedure) 鈥渢o keep it simple,鈥� Jay says, so you may want to check with payers about their policies.
Medicare recognized all joint MRI exams as eligible for bilateral payment as of Jan. 1, 2004, so securing reimbursement for this service should not be a problem--as long as you code according to your intermediary. For example, some payers require you to report the CPT code twice, appending 50 to the second code,
while for others, you should report the code once and append 50 to indicate a bilateral procedure.
Bottom line: Codes 73721-73723 represent unilateral studies. CPT Assistant tells you that to report bilateral studies you need to check your payer policies to determine the correct modifier to indicate two studies, says Rehna Burge, coder at North Oaks Health System, a Hammond, La., medical center.
Steer Clear of This Pelvis MRI Pitfall
When you need to code for bilateral hip MRIs, don鈥檛 fall for the temptation to report an MRI of the pelvis (72195-72197, Magnetic resonance [e.g., proton] imaging, pelvis ...). The CPT [...]

- Published on 2005-09-21