I am hoping someone can assist me with an issue I am having with Capital BlueCross. I am trying to bill for a Left ankle and Left foot MRI. It is the same cpt code and the same dx code for both tests. CBC paid one and rejected one as a duplicate. They were initially billed on sep claims. I took their advice and adjusted the claim. I put them on the same claim and the same line and billed with 2 units. They did not like this either. Has anyone experienced this problem? My last resort is to submit a paper claim adj form and include the separate reports, but I was hoping to correct the claim electronically on their site as it is quicker. I am open to any suggestions.
The CPT index points you to lower extremity codes 73718-73719 (Magnetic resonance [e.g., proton] imaging, lower extremity other than joint …) for "MRI, foot" and joint codes 73721-73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity …) for "MRI, ankle," but the answer is not always that simple.
Reporting a foot MRI depends on the study, according to the AMA and ACR’s Clinical Examples in Radiology, Spring 2007. If the physician orders an ankle study, but the radiologist decides to expand the field of view to include more of the foot, you should only report the appropriate joint code (73721-73723), the article says. But if you have separate setups for each, you may report both a joint (73721-73723) and non-joint (73718-73720) code.