How To Use CPT Code 70543

CPT 70543 is a code for magnetic resonance imaging (MRI) of the orbit, face, and/or neck with and without contrast material. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 70543 procedures.

1. What is CPT 70543?

CPT 70543 is a code used to describe a specific type of magnetic resonance imaging (MRI) procedure that involves the orbit, face, and/or neck. This procedure is performed with and without the use of contrast material to help diagnose various disorders, including tumors and other anatomic abnormalities.

2. 70543 CPT code description

The official description of CPT code 70543 is: “Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences.”

3. Procedure

The 70543 procedure involves the following steps:

1. The patient is positioned on a table that slides into the MRI machine, which looks like a large tube.
2. The patient remains still while the provider uses the machine to create images of one or more structures of the eye’s orbit, the face, and the neck.
3. The machine creates a magnetic field and directs radio waves at the patient’s body, aligning the patient’s hydrogen atoms.
4. The aligned atoms produce signals that a computer uses to create images that show detailed cross sections of the target area.
5. The provider then injects contrast material and takes another series of images.
6. These images help the provider identify tumors and other anatomic abnormalities, as well as foreign bodies.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 70543 services are those who require detailed imaging of the orbit, face, and/or neck to diagnose or evaluate various disorders, including tumors, anatomic abnormalities, or foreign bodies. The use of contrast material in this procedure helps to enhance the visibility of certain structures and abnormalities, making it easier for the provider to make an accurate diagnosis.

5. When to use CPT code 70543

It is appropriate to bill the 70543 CPT code when a provider performs an MRI of the orbit, face, and/or neck with and without contrast material. This code should be used when the provider needs to obtain detailed images of the target area to diagnose or evaluate various disorders, including tumors, anatomic abnormalities, or foreign bodies.

6. Documentation requirements

To support a claim for CPT 70543, the following information should be documented:

• Indication for the MRI, including the specific disorder or condition being evaluated.
• Details of the MRI procedure, including the use of contrast material and the specific structures imaged.
• Findings from the MRI, including any abnormalities or foreign bodies identified.
• Interpretation of the MRI images by the provider, including any diagnoses or recommendations for further evaluation or treatment.

7. Billing guidelines

When billing for CPT code 70543, keep in mind the following guidelines and rules:

• Report 70540 – 70543 once per imaging session.
• If the provider administers oral or rectal contrast, code the service as without contrast because the radiology service includes oral and rectal contrast.
• To assign a code whose descriptor includes contrast, the contrast must be intravascular, intraarticular, or intrathecal.
• Depending on the payer’s guidelines, providers who supply contrast may also separately report the contrast using a 99070 supply code or a HCPCS Level II code. Check individual payers’ policies for contrast coverage and reportable supply codes.
• If you are reporting only the physician’s interpretation for the radiology service, you should append professional component modifier 26 to the radiology code.
• If you are reporting only the technical component for the radiology service, you would append modifier TC to the radiology code. Note, however, that payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical.
• Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 70543 was added to the Current Procedural Terminology system on January 1, 2001. The code was changed on January 1, 2007, with the previous descriptor being “Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast material(s), followed by contrast material(s) and further sequences.”

9. Similar codes to CPT 70543

Five similar codes to CPT 70543 and how they differentiate from CPT 70543 are:

• CPT 70540: This code is for an MRI of the orbit, face, and/or neck without contrast material.
• CPT 70542: This code is for an MRI of the orbit, face, and/or neck with contrast material only.
• CPT 70544: This code is for an MRI angiography of the orbit, face, and/or neck without contrast material.
• CPT 70545: This code is for an MRI angiography of the orbit, face, and/or neck with contrast material only.
• CPT 70546: This code is for an MRI angiography of the orbit, face, and/or neck without contrast material, followed by contrast material and further sequences.

10. Examples

Here are 10 detailed examples of CPT code 70543 procedures:

1. An MRI of the orbit, face, and neck to evaluate a suspected orbital tumor, with and without contrast material.
2. An MRI of the face and neck to assess for possible lymph node involvement in a patient with head and neck cancer, with and without contrast material.
3. An MRI of the orbit and face to investigate a suspected foreign body in the eye, with and without contrast material.
4. An MRI of the neck to evaluate a patient with suspected cervical spine pathology, with and without contrast material.
5. An MRI of the orbit, face, and neck to assess for possible vascular malformations, with and without contrast material.
6. An MRI of the face and neck to evaluate a patient with suspected parotid gland tumor, with and without contrast material.
7. An MRI of the orbit and neck to assess for possible optic nerve compression in a patient with Graves’ disease, with and without contrast material.
8. An MRI of the face to evaluate a patient with suspected sinusitis and possible complications, with and without contrast material.
9. An MRI of the orbit, face, and neck to assess for possible cranial nerve involvement in a patient with neurofibromatosis, with and without contrast material.
10. An MRI of the neck to evaluate a patient with suspected carotid artery stenosis, with and without contrast material.