June 30, 2004

ACR Radiology Coding Source™ May-June 2004 Q and A

Q: When digital subtraction is used in conjunction with a breast MRI with contrast study, is it appropriate to report code 76350 (subtraction in conjunction with contrast studies)?

A: No, the subtraction code 76350 (subtraction in conjunction with contrast studies) was developed prior to digitization when the creation of plain film subtraction images was done in the darkroom. Code 76350 should not be reported in addition to the code for a breast MRI with contrast study or any other MRI study.

Digital subtraction is a scanner-performed function that generates another set of images. This is not dissimilar to another pulse sequence in MR or another set of windows in CT. Therefore, the digital subtraction would be inherent to the MR breast procedure. It is not a postprocessing function on a separate workstation.

Q: How would an MRA of both the right and left subclavian arteries be reported?

A: When an MRA of the right and left subclavian arteries is performed, with the subclavian artery ending at the axilla, which is coincidentally at the lateral margin of the chest, it is appropriate to report an MRA of the chest (71555) once, even if both right and left subclavian arteries are examined. However, if the requested diagnostic imaging extends into the right and/or left axillary arteries and beyond to include the upper extremity(ies), then it would be appropriate to code for the MRA of the upper extremity (73225) in addition to the MRA of the chest. If an MRA study of an upper extremity includes the ipsilateral subclavian artery, this should be coded as an MRA of the upper extremity only (73225).

Q: What is the appropriate CPT® code for reporting an MRI of a pregnant uterus?

A: To report an MRI of a pregnant uterus (fetus) use the unlisted MRI procedure code 76498 [unlisted magnetic resonance procedure (eg, diagnostic, interventional)]. The MRI evaluation of a pregnant uterus requires additional physician work relative to the MRI of the pelvis (not dissimilar from the difference between ultrasound of the pelvis and ultrasound of the pregnant uterus). For example, an MRI of the pelvis would include evaluation of the uterus, ovaries, and adnexa, where the evaluation of a pregnant uterus (fetus) includes evaluation of the fetus for viability, placental position and anatomy, qualitative assessment of amniotic fluid, etc., in addition to the examination of the maternal uterus and adnexa.