Lesley Posted Wed 03rd of February, 2010 20:08:28 PM
Does anyone know where you can find documentation on whether or not CPT code 72148 (MRI of lumbar spine) includes flexion and extension views? From what I am gathering...it is included, however I have not been able to find this in writing anywhere so I can argue this point. Our centers are wanting to try to bill seperately for this using the unlisted procedure code 76498.
Melanie Answered Wed 03rd of February, 2010 20:19:52 PM
CPT 72148 reads:
magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material.
This is subjected to cci-edits
Keep in mind... if you are billing professional component-only - mod 26 must be used. If you are billing technical component only - mod TC must be used.
The verbiage in the root code does not indicate anything specific for body-positioning.
IMPORTANT NOTE: CPT 76498 falls in the category of "Magnetic Resonance Spectroscopy" and is described as: Unlisted Magnetic resonance procedure (eg diagnostic, interventional)
******Unless you are actually scoping the patient, you cannot use this code. Its an entirely different procedure and will guarantee a denial looking for records.
If you did multiple views - I believe this falls under the 100%/50%/50%/50%-yadda yadda yadda... first one is paid at 100%, second one is decreased.... but again, this can get insurance-specific.
Harvard Pilgrim for our area of the country did a HUGE decrease in payments for multiple xrays for relative body-scans/images.... so, cover your butt!