Brain MRI can be billed with CPT 70551, CPT 70552, and CPT 70553. MRI of the brain without contrast material can be billed with the 70551 CPT code, if the procedure was performed with contrast material, CPT 70552 can be used and if the procedure initially was performed with contrast material, but it was followed by contrast material, CPT code 70553 may be reported.
An MRI is frequently used to identify problems with ligaments, the brain, spinal cord, heart, and internal organs such as the lungs, liver, and prostate. Using a magnetic field and protons within the body, an MRI generates sections of pictures.
The slices merge to create three-dimensional images. This precise imaging aids doctors in distinguishing between normal and diseased tissue.
There are three CPT codes for Brain Stem MRI: MRI with contrast, MRI without contrast, and MRI with and without distinction.
- CPT 70551 is an MRI brain stem w/o dye.
- CPT 70552 is an MRI brain stem w/dye.
- CPT 70553 is an MRI brain stem w/o & w/dye.
Descriptions Of The CPT Codes For Brain MRI
Magnetic resonance imaging defines as imaging of the brain with or without contrast. Magnetic resonance imaging (MRI) is a non-surgical, radiation-free method of creating high-resolution sectional images of the inside of the body in multiple planes.
When subjected to radio waves under a high electromagnetic field, the hydrogen atoms in our bodies generate radio frequency signals used in MRI.
The computer uses these signals to analyze and turn them into high-resolution, three-dimensional tomographic pictures. MRI prohibits patients with metallic or electronic implants or foreign entities.
Instead, the patient must lie immobile on a mechanical table within the enormous, circular MRI tunnel. A sedative, as well as contrast material for visual enhancement, may be used.
The provider uses magnetic resonance imaging (MRI) to scan the brain, including the brain stem. The technician performs the first procedure without contrast material and then contrast material.
MRI Brain CPT 70551, CPT 70552, and CPT 70553: Images of the brainstem and posterior brain by a brain MRI are easily visible, which is difficult to see on a CT scan. It can help diagnose demyelinating illnesses (disorders that cause the myelin sheath of the nerve to be destroyed, such as multiple sclerosis (MS)).
Below are the official descriptions of the CPT codes for Brain MRI.
Description of CPT 70551: “Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material.”
Description of CPT 70552: “Magnetic resonance (e.g., proton) imaging, brain (including brain stem); with contrast material(s).”
Description of CPT 70553: “Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences.”
When medical indications are confirmed, the following are examples of signs of a brain MRI:
- Multiple sclerosis (MS) evaluations
- Evaluation of seizure disorder
- Assessment of Parkinson’s disease
- To evaluate neurologic symptoms
- To assess mass, trauma, or metastasis
- To examine headache
- For examination of stroke
- For analysis of infection and inflammatory disease
- For analysis of any congenital abnormality, e.g., craniosynostosis or hydrocephalus
MRI procedure codes are 71552, 70549, 70553, 70559, 72197, 73220, 73223, 73720, 73723, and 74183. These contain an MRI sequence without contrast material, followed by an MRI sequence with contrast media and other MRI sequences.
The contrast material used may be separately payable. Medicare will not pay an additional MRI payment in the subsequent sequence phase. The processes indicated above are reportable once each day.
Billing Guidelines & Reimbursement Policy
The 70551 CPT code is reportable when the technician uses an MRI of the brain without contrast material, including the brain stem.
Likewise, CPT code 70552 is notifiable with contrast material when the technician uses an MRI of the brain, including the brain stem. In contrast, CPT 70553 MRI of the brain, including the brain stem, is used without contrast material, followed by contrast material(s) and different sequences.
The word “with contrast” is used in MRI CPT codes for procedures that use contrast material for imaging enhancement, and it refers to contrast material injected into the body.
Gadolinium is the most often used contrast for MRI. Use the appropriate joint injection CPT code from the musculoskeletal system for intra-articular injection.
When using high-dose contrast, an MRI of the brain or spine is conducted without contrast material initially.
Then a standard (0.1mmol/kg) dose of contrast material, followed by a third MRI with a two-fold amount (0.2mmol/kg) of contrast material based on the requirement for a better view.
For the second MRI, separate billing is not allowed for contrast material. Instead, charge for the contrast material provided for the third MRI procedure using supply code Q9952, the replacement code for A4643, when paid with Current Procedural Terminology (Procedure) codes 70553, 72156, 72157, and 72158.
When a service or procedure shows a separate procedure performed independently or apart from any other services offered at the time, report it separately.
One can represent it as a different process by applying modifier 59 to the particular “separate procedure” code to specify that this procedure is not a component of another service on a claim.
According to the ICD-10-CM guideline regulation, the claims may get denied with mutually exclusive code combinations. “Laterality” (affected side of the body) is a coding standard added to relevant ICD-10 codes to improve specificity.
In addition, fractures, burns, ulcers, and some neoplasms have designated regulations that require verification of the side/region of the body where the problem occurs. Insurance companies might deny claims if the coder reported a diagnosis-to-Modifier comparison with an incompatible ICD-10 CM Laterality policy.
NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are Medicare and its administrative contractors’ assessments that give coverage information and assess whether specific services supplied by participating providers are accepted and required.
The NCD/LCDs define whether a service is acceptable and essential in clinical conditions. The coder must compare the LCDs to the corresponding CPTs to determine if the diagnostic codes demonstrate medical necessity.
Suppose an MRI study of the brain (CPT codes 70551 – 70553) and an MRI study of the orbit (CPT codes 70540 – 70543) are medically necessary and performed as separate studies; both are reportable separately.
Reimbursement for MRI imaging (CPT 70551 – CPT 70553) executed on the same anatomical area is limited to one (1) MRI imaging within six months. MRI imaging above one (1) within six months is subject to medical review for medical necessity.
Documentation should include radiology reason for study, radiology comparison study date and time, observation, radiology impression, and recommendation.
Guidelines restrict the reimbursement of MRI imaging (CPT 70551 – CPT 70553) for an oncologic disease receiving active therapy or active treatment completed within the preceding 12 months on the same anatomical area to four (4) MRI imaging.
MRI imaging (CPT 70551 – CPT 70553) for an oncologic disease above four (4) within 12 months requires medical documentation assessment to support medical necessity.
The skilled worker must document the radiology cause for the study, the radiology comparison study date and time, the radiology comparison study observation, the radiologist’s impression, and the radiology study suggestion.
Billing CPT codes 70553 and 70544 during the same encounter is highly inappropriate. Only an MRI brain for IAC readings will be acceptable with the CPT 70553. Therefore, when billing for an IAC study, the CPT codes 70551 and 70552 will be rejected.
Suppose the health professional uses magnetic spectroscopy, then one must report the CPT 76390 for neurofunctional scans performed by someone who’s not a physician or a psychologist.
Use CPT 70554 when a physician or psychologist does neurofunctional scans and provides radiology treatments without anesthesia.
Report the CPT 01922 in the few cases requiring an anesthetic agent. In addition to A9576 – A9579, and A9581, the coder can also utilize CPT Q9953 – CPT Q9954 to report contrast media. But, again, check with the specific payer to determine coverage.
How To Use Modifiers With CPT 70551, CPT 70552, And CPT 70553
CPT 70551, CPT 70552, and CPT 70553 have technical and professional components. Modifier 26 is for the professional feature, while TC is for the technical detail.
Without a modifier, report the entire procedure (technical and professional). Providers are only authorized to bill professional services in most facilities since the organization holds the technical component.
A doctor performs and supervises MRI exams. Therefore, coding these processes has a technical and professional component. Commonly used modifiers for MRI are 76, 26, TC, and 77. For MRI with contrast, the modifiers used are 50, RT, and LT.
Following the payer’s instructions is essential since certain insurance companies may need you to utilize modifiers RT and LT on two different lines instead of modifier 50.
When numerous modifiers are there in a single claim, ensure that the modifiers are sequenced correctly before processing the claim. For example, modifiers 26, RT, LT, or 59 are reportable in MRI sections, and one should use modifiers in the following order.
The pricing modifiers should be first positioned (e.g., modifier 26 and TC). Informational modifiers (e.g., 59 and 76) come in the second position, while laterality modifiers (e.g., RT or modifier LT) last.
Two MRI codes can be billable if two separate investigations are there during the same session. In this scenario, instead of using modifier 59, use modifier 76.
A patient comes to a radiological hospital for an MRI brain. The technologist initially takes the patient’s images at rest without contrast, followed by contrast material(s) and sequences.
The difference between CPT 70551 and the 70553 CPT code is that if the technician does not use contrast while performing MRI, then use CPT 70551, and if initially MRI is performed without distinction, then MRI with contrast material is used CPT 70553. In this case, the appropriate CPT code used will be 70553.