How To Use CPT Code 72197

CPT 72197 refers to a diagnostic procedure involving magnetic resonance imaging (MRI) of the pelvis, performed without and then with contrast material. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 72197.

1. What is CPT 72197?

CPT 72197 is a diagnostic procedure code used for magnetic resonance imaging (MRI) of the pelvis, performed initially without contrast material and then followed by the administration of contrast material for further sequences. This code is used to report the service when a provider performs an MRI of the pelvis to diagnose, manage, and treat diseases or conditions affecting the pelvic region.

2. 72197 CPT code description

The official description of CPT code 72197 is: “Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences.”

3. Procedure

1. The patient is positioned on the scanning table, and the table slides into the MRI scanner, which is a large tunnel-shaped magnetic device.
2. The provider instructs the patient to hold their breath and remain still while the images are taken.
3. Initial images of the pelvis are captured without the use of contrast material.
4. Contrast material is then administered via injection to enhance the image quality.
5. Further sequences of images are taken with the contrast material.
6. The provider reviews, analyzes, and interprets the images.
7. A written report of the findings is prepared by the provider.

4. Qualifying circumstances

Patients eligible to receive CPT 72197 services are those who require an MRI of the pelvis for the diagnosis, management, or treatment of diseases or conditions affecting the pelvic region. This may include, but is not limited to, patients with pelvic pain, suspected tumors, infections, or injuries. The provider must determine the medical necessity of the procedure based on the patient’s clinical presentation and history.

5. When to use CPT code 72197

It is appropriate to bill CPT 72197 when a provider performs an MRI of the pelvis both without and with contrast material for the purpose of diagnosing, managing, or treating diseases or conditions affecting the pelvic region. The use of contrast material should be medically necessary and based on the patient’s clinical presentation and history.

6. Documentation requirements

To support a claim for CPT 72197, the following information should be documented:

• Patient’s medical history and clinical presentation
• Indication for the MRI of the pelvis
• Details of the procedure, including the use of contrast material
• Provider’s interpretation and analysis of the images
• Written report of the findings

7. Billing guidelines

When billing for CPT 72197, keep in mind the following guidelines:

• Append professional component modifier 26 to the radiology code when reporting only the physician’s interpretation of the radiology service.
• Append modifier TC to the radiology code when reporting only the technical component of the radiology service. Note 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.
• Code the service as without contrast when the provider administers oral or rectal contrast, as the radiology service includes oral and rectal contrast.
• Check individual payers’ policies for contrast coverage and reportable supply codes when providers supply contrast.

8. Historical information

CPT 72197 was added to the Current Procedural Terminology system on January 1, 2001. There have been no updates to the code since its addition.

9. Similar codes to CPT 72197

Five similar codes to CPT 72197 and how they differ are:

• CPT 72195: MRI of the pelvis without contrast material only.
• CPT 72196: MRI of the pelvis with contrast material only.
• CPT 74712: MRI of a fetus, without and with contrast material.
• CPT 74713: MRI of a fetus, without contrast material only.
• CPT 72198: MRI of the pelvis, without and with contrast material, for vascular structures.

10. Examples

Here are 10 detailed examples of CPT 72197 procedures:

1. A patient with chronic pelvic pain undergoes an MRI of the pelvis without and with contrast material to identify any underlying pathology.
2. A patient with a suspected pelvic tumor undergoes an MRI of the pelvis without and with contrast material to determine the extent of the tumor and plan treatment.
3. A patient with a history of endometriosis undergoes an MRI of the pelvis without and with contrast material to evaluate the current status of the disease.
4. A patient with a suspected pelvic infection undergoes an MRI of the pelvis without and with contrast material to identify the source of the infection and guide treatment.
5. A patient with a history of pelvic trauma undergoes an MRI of the pelvis without and with contrast material to assess the extent of the injury and monitor healing.
6. A patient with unexplained urinary symptoms undergoes an MRI of the pelvis without and with contrast material to evaluate the urinary system and identify any abnormalities.
7. A patient with a suspected pelvic abscess undergoes an MRI of the pelvis without and with contrast material to confirm the diagnosis and guide treatment.
8. A patient with a history of pelvic surgery undergoes an MRI of the pelvis without and with contrast material to evaluate postoperative complications or recurrence of the initial condition.
9. A patient with a suspected pelvic fracture undergoes an MRI of the pelvis without and with contrast material to confirm the diagnosis and plan treatment.
10. A patient with a suspected pelvic vascular malformation undergoes an MRI of the pelvis without and with contrast material to evaluate the extent of the malformation and guide treatment.