August 31, 2010

ACR Radiology Coding Source™ July-August 2010 Q and A

Q: Is it appropriate to report an MRI brain code for the axial images acquired as part of an MRA study? If not, when is it appropriate to report both brain MRI and brain MRA codes?

A: No, it is not appropriate to report a magnetic resonance imaging (MRI) brain code for the axial source images acquired as part of a magnetic resonance angiography (MRA) study. The axial source images are an integral portion of the MRA examination. While some lesions may be visible on the MRA axial source images, these images are specifically designed to minimize brain parenchymal resolution in order to optimize visualization of the vasculature. 

Only when a full and complete brain MRI is performed separate from a full and complete MRA examination (separate data set acquisition) would it be appropriate to report both an MRI and MRA code. When medically necessary, MRI and MRA exams can be complementary. MRI and MRA of the brain represent separate procedures, each with a distinct anatomic target - the nervous system (extra-vascular) and its vascular system (intra-vascular). The two procedures employ distinctly different imaging protocols, and separate reports are generated. In this instance, the use of modifier 59 is appropriate, even though the distinct anatomic targets are both intracranial in location. As noted in the AMA’s Coding with Modifiers guide, in order to use modifier 59, documentation needs to be specific to the distinct procedure or service and be clearly identified in the medical record.1 

1Coding with Modifiers: A Guide to Correct CPT® and HCPCS Level II Modifier Usage, Second Edition, Copyright 2006, AMA, p. 173. 

Q: We performed discography injections of the lumbar spine at the L1-L2 and L3-L4 levels. What CPT® code(s) is used to report this study? Is it appropriate to report the fluoroscopic guidance code 77003 for the needle injection as well?

A: Injections at the L1-L2 and L3-L4 levels of the lumbar spine for discography are appropriately reported with code 62290 (Injection procedure for discography, each level; lumbar). The associated imaging code 72295 (Discography, lumbar, radiological supervision and interpretation) also should be reported. Both the surgical (62290) and radiological supervision and interpretation (72295) codes should be reported twice – once for each level injected and studied. 

No, it is not appropriate to report the fluoroscopic guidance code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, Transforaminal epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction), as the work for fluoroscopy has been valued into the discography imaging codes 72285 and 77295. 

For cervical and thoracic discography, see codes 62291 and 72285. 

CPT Assistant, Nov 99:35, 40; Apr 03:27 
CPT Changes: An Insider’s View 2000 
ACR Radiology Coding Source, March/April 2006