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Orthopedic Coding Alert

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Know the Lower-Extremity MRI Rules

Make the most of modifiers for leg-joint imaging reports Even if you-re familiar with coding lower-body MRIs, you may not know which code to report when the surgeon images more than one joint. We-ll show you how to select an accurate code and append the appropriate modifiers to your imaging claims. Straightforward Coding for a Standard MRI Problem: You won't find -MRI; Hip- in your CPT index. Instead, when the order is for a hip MRI, you should choose the proper code from 73721-73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity ...) because the hip is a joint, says Sandi Scott, CPC, PMCC, instructor and director of audit and training for InSight Health Corp. in Lake Forest, Calif.

Keep an eye out for whether you need to designate which aspect of the MRI you-re reporting, says Rhonda Jay, quality assurance specialist for Southwest Diagnostic Imaging in Dallas.

Append modifier 26 (Professional component) if you-re coding only the surgeon's interpretation of the image, or append TC (Technical component) if you-re reporting only the imaging itself.

Most likely, however, if you-re coding MRIs, your practice probably owns the equipment, and an employee performs the MRI itself, while a surgeon at your practice interprets the results and writes a report. In that case, you should report the global code without modifiers 26 or TC. Bolster Your Bilateral Hip MRI Coding If your documentation reveals a bilateral MRI of the hips, your modifier choice could be the difference between payment and denial.

Some payers--especially Medicare--seem to prefer that you report the MRI code with LT (Left side) and RT (Right side), Jay says. Texas Medicare has even suggested using LT and RT with 76 (Repeat procedure by same physician), she adds.

Example: The orthopedist reviews bilateral hip MRIs performed with contrast that a staff member administered using your practice's own equipment. In this situation, you should report 73722-LT (... with contrast material[s]), 73722-76-RT.
Other payers prefer that you use modifier 50 (Bilateral procedure) -to keep it simple,- Jay says.

Medicare recognized all joint MRI exams as eligible for bilateral payment as of Jan. 1, 2004, so securing reimbursement for this service should not be a problem--as long as you code according to your carrier.

Some payers require you to report the CPT code twice, appending 50 to the second code, while for others, you should report the code once and append 50 to indicate a bilateral procedure.

Bottom line: Codes 73721-73723 represent unilateral studies--the July 2001 CPT Assistant reminds coders that to report bilateral studies you need to check your payer policies to determine the correct modifier to indicate two studies.

Steer Clear of This Pelvis MRI Pitfall When you need to code for bilateral hip MRIs, don't [...]

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