Forum - Questions & Answers
MRI coding
If you code 2 MRI's on 2 different body parts in the same day. What modifier do you use to get them to pay both at full fee schedule. i am finding that they are reducing the payment of the second MRI payment almost in half.
re: MRI coding
I pulled this from the ACR (Academy of Radiology) website...maybe this can give you some insight.
Congress mandated that the multiple procedural payment reduction rule (MPPR) be changed from 25 to 50 percent for CT, CTA, MRI, MRA, and ultrasound. These codes are within the 11 families of codes to which this applies.
Effective January 1, 2011, within the 11 families, when two or more codes are performed to the same patient by the same physician during a single session (i.e., one encounter), the technical component for the second and subsequent imaging procedure will be reduced by 50 percent.
The following breast codes are on the MPPR list.
Code Short descriptor
77058 Magnetic image, breast
77059 Magnetic image, both breasts
CMS finalized their proposal so that the MPPR applies to non-contiguous procedures and across modalities. If two or more of the codes above are performed during a single session, the lower payment procedure will be reduced by 50 percent. If one of the codes listed above is performed with another code within the 11 families, the MPPR will also apply.
If a screening or diagnostic mammogram is performed with one of the codes listed above or with another code within the 11 families, the MPPR does not apply as the screening and diagnostic mammogram studies are not on the MPPR list.
If two procedures listed above are performed at different times on the same day, the MPPR does not apply as they are considered to be multiple sessions. A modifier 59 will have to be submitted with the claim. If one of the procedures listed above is performed with another code within the 11 families at different times on the same day, the MPPR does not apply.
CMS believes that this proposal is consistent with their overall strategy to pay more appropriately for services that are commonly provided together.
For a complete list of codes on the MPPR list (starts on page 1942), please click here.
For any questions related to MPPR, please contact the Economics and Health Policy Department.
re: MRI coding
This does not just apply to Breast procedures...FYI
re: MRI coding
Modifier -59 but each payer will have their own policies
