How To Use CPT Code 77049

CPT 77049 refers to a magnetic resonance imaging (MRI) procedure of the breast, performed with and without contrast material, including computer-aided detection (CAD). This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77049.

1. What is CPT 77049?

CPT 77049 is a medical billing code used to describe a specific type of breast MRI procedure that involves the use of contrast material and computer-aided detection (CAD) technology. This code is utilized by healthcare providers to accurately document and bill for this particular diagnostic imaging service.

2. 77049 CPT code description

The official description of CPT code 77049 is: “Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral.”

3. Procedure

  1. The patient is positioned on the MRI table, and the breasts are placed within a specialized coil designed for breast imaging.
  2. Initial MRI images of both breasts are obtained without the use of contrast material.
  3. A contrast medium is intravenously injected into the patient.
  4. Additional MRI images of both breasts are taken with the contrast material.
  5. The MRI images are processed and analyzed using computer-aided detection (CAD) software, which assists in identifying and characterizing any lesions present.
  6. The healthcare provider evaluates the CAD-generated images and data, along with the original MRI images, to make a final assessment and dictate a report.

4. Qualifying circumstances

Patients who may be eligible to receive CPT 77049 services include those with a personal or family history of breast cancer, individuals with dense breast tissue, or those who have previously undergone breast surgery or radiation therapy. Additionally, this procedure may be recommended for patients with inconclusive results from other imaging modalities, such as mammography or ultrasound, or for those who require further evaluation of a known breast abnormality.

5. When to use CPT code 77049

CPT 77049 should be used when billing for a bilateral breast MRI procedure that includes both non-contrast and contrast-enhanced imaging, as well as the use of computer-aided detection (CAD) technology. This code is appropriate for cases where the healthcare provider determines that this specific diagnostic imaging service is medically necessary for the patient’s evaluation and management.

6. Documentation requirements

To support a claim for CPT 77049, healthcare providers must document the medical necessity of the procedure, including the patient’s relevant medical history, clinical findings, and the rationale for performing a bilateral breast MRI with contrast and CAD. Additionally, the provider should include a detailed description of the procedure, the results of the CAD analysis, and their final assessment and recommendations based on the imaging findings.

7. Billing guidelines

When billing for CPT 77049, it is essential to follow payer-specific guidelines and requirements. Providers who supply contrast may also separately report the contrast using a 99070 supply code or a HCPCS Level II code, depending on the payer’s policy. If reporting only the physician’s interpretation for the radiology service, append professional component modifier 26 to the radiology code. For reporting only the technical component, append modifier TC to the radiology code. However, some payer policies may exempt hospitals from appending modifier TC, as their portion is inherently technical. Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT 77049 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 77049

Several codes are similar to CPT 77049 but differ in specific aspects of the procedure:

  • CPT 77046: Refers to a breast MRI without contrast material, performed on both breasts.
  • CPT 77047: Refers to a breast MRI without contrast material, performed on one breast.
  • CPT 77048: Refers to a breast MRI with and without contrast material, including CAD, performed on one breast.
  • CPT 77058: Refers to a unilateral breast MRI, without specifying the use of contrast material or CAD.
  • CPT 77059: Refers to a bilateral breast MRI, without specifying the use of contrast material or CAD.

10. Examples

Here are ten detailed examples of CPT code 77049 procedures:

  1. A patient with a strong family history of breast cancer undergoes a bilateral breast MRI with contrast and CAD to screen for early signs of malignancy.
  2. A patient with dense breast tissue undergoes CPT 77049 to further evaluate an abnormality detected on a mammogram.
  3. A patient with a history of breast surgery and radiation therapy undergoes CPT 77049 for post-treatment surveillance and assessment of potential recurrence.
  4. A patient with inconclusive ultrasound findings undergoes CPT 77049 to clarify the nature of a breast lesion.
  5. A patient with a known breast abnormality undergoes CPT 77049 to determine the extent of the lesion and guide treatment planning.
  6. A patient with a palpable breast mass undergoes CPT 77049 to characterize the mass and assess for additional lesions.
  7. A patient with a BRCA gene mutation undergoes CPT 77049 for high-risk breast cancer screening.
  8. A patient with a history of atypical ductal hyperplasia undergoes CPT 77049 to monitor for potential malignant transformation.
  9. A patient with a suspicious mammographic finding undergoes CPT 77049 to further evaluate the lesion and determine the need for biopsy.
  10. A patient with a history of breast implants undergoes CPT 77049 to assess for implant rupture or complications.

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