How To Use CPT Code 70555

CPT 70555 describes the procedure of functional magnetic resonance imaging (MRI) of the brain, which involves assessing the metabolic changes in response to neural activity. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 70555?

CPT 70555 is used to describe the procedure of functional MRI of the brain. This imaging technique tracks brain activity by assessing the metabolic changes that occur in response to neural activity. It provides valuable information about brain function and can help in diagnosing, managing, and treating various diseases and conditions.

2. Official Description

The official description of CPT code 70555 is: ‘Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing.’ This code should only be reported if code 96020 is performed as well. Additionally, it should not be reported in conjunction with codes 70554 and 70555 unless a separate diagnostic MRI is performed.

3. Procedure

1. The patient is positioned appropriately and may be sedated if necessary.
2. A radio antenna device called a surface coil is placed around the upper part of the head.
3. The patient is placed on a sliding table and inserted into the MRI scanner.
4. The patient is instructed to remain still during the procedure.
5. The MRI scanner uses magnetic fields and radio waves to visualize the brain tissues.
6. The provider records a series of images while the patient performs tasks or experiences visual stimulation.
7. The provider analyzes the images to evaluate the effect of the tasks or stimulation on brain function.
8. If necessary, additional images may be taken for a more detailed study.
9. The provider reviews the images to determine if further imaging is required.

4. Qualifying circumstances

CPT 70555 requires the presence of a physician or psychologist to administer the entire neurofunctional testing during the functional MRI of the brain. This code should only be used when the testing specifically requires the involvement of a physician or psychologist.

5. When to use CPT code 70555

CPT code 70555 should be used when a functional MRI of the brain is performed, and the testing requires the administration of the entire neurofunctional testing by a physician or psychologist. It is important to ensure that the specific circumstances of the procedure meet the requirements outlined in the code description.

6. Documentation requirements

To support a claim for CPT 70555, the provider must document the following information:

• Reason for performing the functional MRI of the brain
• Details of the entire neurofunctional testing administered by the physician or psychologist
• Date and duration of the procedure
• Any specific tasks or visual stimulation used during the testing
• Analysis and evaluation of the images to assess brain function
• Any additional imaging or follow-up recommendations

7. Billing guidelines

When billing for CPT 70555, it is important to ensure that the procedure meets the requirements outlined in the code description. Additionally, consider the following billing guidelines:

• Do not report CPT 70555 unless code 96020 is also performed.
• Do not report CPT 70554 or 70555 in conjunction with codes 70551-70553 unless a separate diagnostic MRI is performed.
• Use modifier 26 to indicate the professional component if reporting only the physician’s interpretation for the radiology service.
• Use modifier TC to indicate the technical component if reporting only the technical component for the radiology service.
• Do not append a professional or technical modifier to the radiology code when reporting a global service where one provider renders both the professional and technical components.

8. Historical information

CPT 70555 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician administering the entire neurofunctional testing during a functional MRI of the brain to evaluate language function in a patient with a suspected brain tumor.
2. A psychologist conducting the entire neurofunctional testing during a functional MRI of the brain to assess memory function in a patient with Alzheimer’s disease.
3. A physician administering the entire neurofunctional testing during a functional MRI of the brain to evaluate motor function in a patient with Parkinson’s disease.
4. A psychologist conducting the entire neurofunctional testing during a functional MRI of the brain to assess cognitive function in a patient with traumatic brain injury.
5. A physician administering the entire neurofunctional testing during a functional MRI of the brain to evaluate visual processing in a patient with a suspected visual impairment.
6. A psychologist conducting the entire neurofunctional testing during a functional MRI of the brain to assess attention and concentration in a patient with attention deficit hyperactivity disorder.
7. A physician administering the entire neurofunctional testing during a functional MRI of the brain to evaluate emotional processing in a patient with depression.
8. A psychologist conducting the entire neurofunctional testing during a functional MRI of the brain to assess executive function in a patient with a history of stroke.
9. A physician administering the entire neurofunctional testing during a functional MRI of the brain to evaluate sensory processing in a patient with a suspected sensory processing disorder.
10. A psychologist conducting the entire neurofunctional testing during a functional MRI of the brain to assess social cognition in a patient with autism spectrum disorder.