Reader Question: MRI of the Brain- Published on Thu, Jun 01, 2000
Question: Could you please help me with the following scenario: A Medi-cal (California Medicaid) patient had a brain MRI with and without contrast. The diagnosis in the report states that the patient has metastatic lung cancer, which required screening for brain metastases. Is there an acceptable ICD-9 code that would be used in this situation?
Diversified Billing, Lafayette, Calif. Answer:
According to Medicare, an entire range of neoplasm codes are considered covered diagnoses for an MRI (magnetic resonance imaging) of the brain. This range includes 141.X (malignant neoplasm of tongue
) through 208.9X (leukemia of unspecified cell type
). Although this seems like a broad spectrum, it makes sense when you realize that many of these covered neoplasms put a patient at great risk for a brain metastasis. If your code falls within this coding range, you likely have a payable diagnosis.
In the instance described, code the lung neoplasm as the primary diagnosis. Choose from codes 162.3 (malignant neoplasm of trachea, bronchus, and lung; upper lobe, bronchus or lung
), 162.4 (middle lobe, bronchus or lung
), 162.5 (lower lobe, bronchus or lung
), 162.8 (other parts of bronchus or lung
) or 162.9 (bronchus and lung, unspecified
The code assigned for the MRI may include 70551 (magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material
), 70552 (with contrast material[s]
), or 70553 (without contrast material, followed by contrast material[s] and further sequences
), depending on the procedure performed. Source for this Reader Question is Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispecialty group practice in Buckhannon, W.Va.