How To Use CPT Code 72196

CPT 72196 describes the use of magnetic resonance imaging (MRI) with contrast material to visualize and diagnose conditions in the pelvis. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 72196?

CPT 72196 is used to describe the diagnostic procedure of magnetic resonance imaging (MRI) of the pelvis with the use of contrast material. This code is specifically for imaging the pelvis and provides detailed visualization of the internal structures and organs in that area.

2. Official Description

The official description of CPT code 72196 is: ‘Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s).’ This code indicates that the MRI of the pelvis is performed using contrast material to enhance the visibility of the structures being imaged.

3. Procedure

1. The patient is positioned on the scanning table and enters the MRI machine, which creates a strong magnetic field.
2. The provider may instruct the patient to hold their breath and remain still during the imaging process.
3. Contrast material is administered to the patient, either orally or intravenously, to improve the visibility of the pelvis structures.
4. The MRI machine captures radiofrequency signals emitted by the body, which are then processed by a computer to generate detailed images of the pelvis.
5. The provider reviews the images and interprets the results to make a diagnosis or assess the patient’s condition.
6. A written report is prepared by the provider, documenting their findings and recommendations.

4. Qualifying circumstances

CPT 72196 is used when an MRI of the pelvis is performed with the administration of contrast material. The contrast material can be intravascular, intraarticular, or intrathecal. This code is appropriate when the use of contrast material is necessary to enhance the visibility of the pelvis structures and aid in the diagnosis or management of the patient’s condition.

5. When to use CPT code 72196

CPT code 72196 should be used when an MRI of the pelvis is performed with the administration of contrast material. It is important to ensure that the use of contrast material is medically necessary and will provide additional diagnostic information compared to an MRI without contrast. This code should not be used if contrast material is not administered during the imaging procedure.

6. Documentation requirements

To support a claim for CPT 72196, the provider must document the following information:

• Indication for the MRI of the pelvis
• Administration of contrast material and the type used
• Date and time of the procedure
• Any specific findings or abnormalities observed
• Interpretation of the images and diagnosis, if applicable
• Signature of the interpreting provider

7. Billing guidelines

When billing for CPT 72196, it is important to ensure that the procedure meets the requirements for the use of contrast material. The use of contrast material should be documented in the medical record and supported by medical necessity. If only the interpretation of the MRI is being reported, the professional component modifier 26 should be appended to the code. If only the technical component is being reported, modifier TC should be appended. It is also important to check payer policies regarding the reporting of contrast material separately, as some payers may allow for separate reporting using specific supply codes.

8. Historical information

CPT 72196 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes an MRI of the pelvis with contrast material to evaluate a suspected pelvic mass.
2. An individual with a history of pelvic inflammatory disease receives an MRI of the pelvis with contrast material to assess for any complications or residual inflammation.
3. A patient with suspected endometriosis undergoes an MRI of the pelvis with contrast material to visualize any abnormal growths or lesions.
4. An oncology patient receives an MRI of the pelvis with contrast material to monitor the response to treatment and assess for any tumor recurrence.
5. A patient with chronic pelvic pain undergoes an MRI of the pelvis with contrast material to identify any potential causes or abnormalities.
6. A pregnant woman receives an MRI of the pelvis with contrast material to evaluate any potential fetal abnormalities or complications.
7. An individual with a history of trauma undergoes an MRI of the pelvis with contrast material to assess for any internal injuries or fractures.
8. A patient with suspected prostate cancer receives an MRI of the pelvis with contrast material to evaluate the extent of the disease and plan appropriate treatment.
9. An individual with a known pelvic abscess undergoes an MRI of the pelvis with contrast material to guide drainage procedures and monitor the response to treatment.
10. A patient with suspected gynecological abnormalities receives an MRI of the pelvis with contrast material to visualize the reproductive organs and identify any potential issues.