CPT code 72148

(2022) CPT Code 72148 – Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 72148 bills for service when the physician performs an MRI scan of the lumbar spine, including spinal canal and contents, without administering contrast.

CPT Code 72148 Summary

MRI is a radiation-free service, painless and not harmful like CT (Computed Tomographic) scans. CPT code 72148 provides high-quality visualization of the cervical spine in multiple planes inside the body.

It will aid in identifying the problem of the soft tissue of the low back, bones, abnormal vertebrae, joint disorders, aneurysms, congenital disabilities, deformities, scoliosis, degenerated and herniated discs of the lumbar region. 

Each image considers a slice, and more than 100 images capture during a complete MRI scan of the cervical spine. Furthermore, the photos are placed in the computer and visualized in a 3D space to focus and diagnose the problem.

MRI of the Lumbar spine uses magnetic properties that produce radiation when this radiation signal reflects with the high-electric magnetic field, resulting in 3D high-resolution images. MRI does not perform on patients with metallic implants or foreign bodies.

The patient can sedate to remain the patient in one place in a large circular tunnel, and contrast can use to enhance the image or visualization. MRI of the Lumbar spine performs in three ways.

The first way is to serve without substance which will report with CPT code 72148. The second is to better act with a contrast medium to visualize the Lumbar spine (CPT 72149). The third is to utilize both ways with and without contrast medium reported by CPT code 72158.

CPT Code 72148 Description

CPT code 72148 bills for service when the physician performs an MRI scan of the lumbar spine, including spinal canal and contents, without administering contrast.

72148 cpt code

CPT Code 72148 Reimbursement 

A maximum of 1 unit of CPT code 72148 can be billed on the same date of service, while three service bills if documentation supports the medical necessity. Modifier 26 and TC apply to this CPT 72148 for reimbursement purposes. 

The cost and RUVs of CPT code 72148 are as follows:

CPT 72148 with modifier 26: (Facility Price: Cost $77.73 RUVS 2.24610) (Non-Facility Price: Cost $77.73 RUVS 2.24610)

CPT 72148 with modifier TC (Technical Component): (Facility Price: Cost $158.29 RUVS 4.57414) (Non-Facility Price: Cost $158.29 RUVS 4.57414)

CPT code 72148 Global price (Without 26 and TC): (Facility Price: Cost $236.02 RUVS 6.82024 Non-Facility Price: Cost $236.02 RUVS 6.82024)

CPT Code 72148 Modifiers

There is the following list of modifiers that are applicable with CPT 72148: 

22, 23, 26, 51, 52, 53, 59, 76, 77, 78, 79, 99, AQ, AI, AR, CC, CR, ET, EY, FX, FY, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, QQ, SG, TC, XE, XS, XP, and XU.

The most frequently used modifiers are 26, TC, 77, 76, 59, or X {E, P, S, U} with CPT 72148. 

Modifier 26 indicates the professional services or equipment. It is applicable with CPT 72148 when the physician performs an MRI of the lumbar spine in a hospital, does not own the equipment used in the Cervical spine, or is an employee in the Facility. 

While modifier TC indicates technical components such as machinery used in MRI Cervical spine CPT 72148, it reports by the hospital or third party who owned the equipment. 

CPT 72148 bills globally when a Lumbar spine MRI perform in a private office or a Physician owns the equipment. Globally billed means without modifier 26 or TC. 

If the same physician performed an MRI of the Lumbar spine twice on the same service date, CPT 72148 reports with Modifier 76. At the same time, an MRI of the Lumbar spine performed by a different Physician on the same day is appropriate to attach modifier 77 with CPT 72148.

Modifier 59 is applicable with CPT 72148 when service is not customarily performed together on the same date but bundled with other procedures. For further specifications, Medicare accepts modifiers XU, XE, XP, and XS instead of modifier 59 with CPT 72148.

Suppose the radiologist is on leave or in the absence of an original physician. In that case, services provided by the temporary physician or substitute physician with modifier Q6 under the name of the original provider, not with Loum tenant. Modifier Q6 is applicable with CPT 72148 for locum tenants’ billing or temporary substitute physician. 

Modifier 53 applies to CPT 72148 when the procedure terminates by the physician due to unavoidable circumstances and plans to repeat the process in the future. In contrast, modifier 52 will be attached to the CPT 72148 if the physician performs the procedure incomplete and does not have a plan to repeat the process.

72148 cpt code description

CPT Code 72148 Billing Guidelines

CPT code 72148 has technical and professional components. Therefore, it should bill with the appropriate 26 or TC modifier. If the physician owns the practice, TC and 26 are not required.

Documentation should support the medical necessity of service and be medically appropriate. The appropriate ICD 10 codes report to the claims for reimbursement. 

The most billed dx codes are from categories M51.26, M51.27, M54.16, M48.061, M48.062, etc. There are specific codes for each Lumbar spondylosis and stenosis and pick the most appropriate code.

 Intrathecal injection CPT codes report with CPT code 72148, and it is appropriate to bill with separate CPT codes 61055 and 62284. 

Radiology services furnish without anesthesia, and it is appropriate to bill with CPT code 01922.

If contrast injects with MRI cervical spine code, it is appropriate to report with HCPCS level 2 codes A9575–A9579, A9581, A9585, and Q9953–Q9954. While CPT code 72148 performs without contrast. Therefore, there is no need to report these codes with CPT code 72148.

The contrast injects via any other route such as intrathecal except intravenous or intraarticular. It does not consider a contrast study, and then it is appropriate to bill with non-contrast CPT code 72148 instead 72149 with contrast codes.

If both contrast and non-contrast study of the Lumbar spine perform on the same day, it reports with combination code 72158 instead of CPT 72148 and 72148 on the same day.

CPT 72148 is allowed to be billed together on the same date of service as CPT code 72158 according to NCCI (National Correct Coding Initiative). Therefore, CPT 72158 bills due to higher reimbursement.

The 3D imaging includes the MRI cervical spine CPT code 72158, and there is no need to report separately. 

If MR spectroscopy (0609T-0610T) performs in combination with CPT code 72148, it is not appropriate to bill separately according to NCCI. CPT code 72148 bills due to a higher payment.

Suppose physicians perform an MRI of the lumbar spine without contrast, and it is not visible. If the same physician performs MRI with contrast, then it is appropriate to bill with CPT code 72158. 

While if a different physician performs a contrast study, it is reasonable to report with two other CPT codes. e.g., MRI Lumbar spine without contrast bills with CPT 72148 for Physician A, and MRI Lumbar spine with contrast bills with modifier 77 with CPT code 72149.

what is cpt code 72148

Examples

The following are examples when CPT code 72148 bills:

Example 1

A 60-year-old female presents to the office with low back pain for four days. The pain gets worse with movement and when lying down. The patient took some medication for pain.

 The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. A physical exam revealed swelling in the lumbar region.

 The physician ordered an MRI of the lumbar spine. It showed the degeneration of the lumbar spine at L4 – L5, L3 – L4, and disk budging at the C4-C5 level. The patient also has spondylosis of the cervical spine. The physician prescribed medicine for pain and treatment and suggested a follow-up every two weeks. 

Example 2

A 16-year-old male presented to the emergency department after a motor vehicle accident today and had a severe headache, back pain, and chest pain

A physical exam revealed back, head, and eye swelling. The patient is unable to move his neck and has severe pain. The patient denies urinary symptoms, extremity pain, and dizziness. 

The physician ordered an MRI of the Lumbar, head, and chest. The patient had multiple fractures of L1-L2 and L3-L4 and ribs. 

The physician ordered fracture splinting and consulted orthopedics for the patient’s current condition and treatment.

Example 3

A 39-year-old male with tumors in the lumbar region presented to the emergency department with c/o constant low back pain that started four days ago. The patient is consulted with his primary care physician and suggested to go emergency department. The patient was unable to walk for 1-week. 

Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. The patient took his routine medication. 

The physician decides to do a surgical procedure to excise cancer. The physician ordered an MRI scan of the lumbar region and laboratory studies to confirm if the tumor metastasized or not. On the second day of surgery, the patient was back with severe pain and agreed to administer an anesthetic agent at L4-45 in the epidural space. 

Similar Posts

Leave a Reply

Your email address will not be published.