Forum - Questions & Answers

Jan 25th, 2019 - rdinaso    12  1 

MRI without contrast on Monday followed by an MRI with contrast on Tuesday.

I need some help. I have a radiologist who will not perform the read on an MRI without contrast done on Monday because he knows that there is an order for the same procedure WITH contrast done on Tuesday, So he creates a report and chooses the CPT code for MRI with and without contrast. I think this is wrong, that he should bill without contrast for Mondays test, and with contrast for Tuesday's test but he won't budge unless I have something in writing. I really can use some advice on this one! TIA!


Jan 28th, 2019 - ChrisW   256  1 

re: MRI without contrast on Monday followed by an MRI with contrast on Tuesday.

If the intention of the procedure is to do the MRI with and without contrast you would bill the appropriate code.

For example;
70553 - Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences.

If billing a CPT code that includes both with and without contrast, you can bill the span of two days if the patient cannot tolerate the time needed to complete the procedure all in one day. You would bill the first date and the second date of service on the To-From portion on the CMS-1500 or UB-04.

If billing the procedure takes two days, the claim will be paid for the one procedure reported, for example, the definition in this code 70553, includes all further sequences. In addition, you would you bill separately for the contrast material used in the second procedure, the second day, as it was already billed in the first procedure. The provider's documentation and the report should reflect this information.

Medicare Claims Processing Manual Chapter 13 - Radiology Services and Other Diagnostic Procedures
40 - Magnetic Resonance Imaging (MRI) Procedures (Rev. 2307, Issued: 09-22-11, Effective: 07-07-11/02-24-11(CR 7296), Implementation: 09-26-11)

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