In the United States alone, almost 40 million MRI exams are conducted each year. MRI scans, one of the most widely used diagnostic imaging methods, are essential to contemporary medicine.
Healthcare providers suggest an MRI to diagnose or track conditions like tumors, strokes, congenital anomalies, infections, multiple sclerosis, and brain traumas. This process involves a detailed examination of the brain’s structure. It provides precise and unambiguous imaging so that providers can make informed treatment choices.
Today, we will discuss CPT code 70551, which is used to bill an MRI process.
CPT Code 70551 Description
Magnetic resonance imaging (MRI) of the brain and brainstem without contrast is reported using CPT code 70551.
The American Medical Association (AMA) maintains this procedural code, which falls under the ‘Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck’ code range.
Appropriate Use Cases for CPT Code 70551
Below are a few scenarios to better understand the use of CPT code 70551.
Brain Aneurysm
Suppose a patient visits a neurologist with sudden and severe headaches impacting the area above and beyond the eyes. The intensity of pain causes nausea and blurred or double vision. The neurologist suggests an MRI without contrast to check the possibility of a brain aneurysm. In this case, CPT code 70551 will be reported.
Hemorrhage
Let’s imagine a case of a young boy who had an accident a few days back and faced a minor head injury. But since that accident, he has been dealing with a constant headache and random racing heartbeats. He goes to see the doctor. The doctor asks him about the accident and post-accident symptoms. He suspects that the boy might have suffered from inner injuries, and it may be a hemorrhage. So he asks the boy to get an MRI test without contrast for confirmation. In this scenario, CPT code 70551 will be used.
Brain Tumor
Let’s imagine a person visits his physician and complains of headaches, nausea, and hearing and vision issues, which are now escalating to seizures. After checking and deeply analyzing his condition, the physician predicts that he might have a brain tumor. But to be sure, he recommends an MRI without contrast. In this case, the neurologist will use CPT code 70551.
Modifiers to Append with CPT Code 70551
You can append various modifiers while submitting claims, depending on the situation and the level of additional services you have offered. However, the following are some modifiers that are usually appended to CPT code 70551.
Modifier 22
You can append modifier 22 if the process takes longer than the usual time and effort.
Modifier 26
Modifier 26 represents the professional component of the services. This modifier is appended when the neurologist bills for his professional services (e.g., writing or analyzing MRI reports).
Modifier TC
Modifier TC represents the technical component of the services. This modifier is appended when the facility (radiology lab) bills for its part in the brain and brainstem MRI scan, e.g., equipment use, technician’s time, and the imaging procedure.
Modifier 76
Modifier 76 is appended when the same physician performs the same procedure or service again on the same patient after the initial one.
Modifier 77
Modifier 77 is appended when a different physician performs the same procedure or service again after the initial one.
Reimbursement Guidelines for CPT Code 70551
Below, we have discussed the billing and reimbursement guidelines for CPT code 70551.
Maintain Detailed Documentation
Your documentation for CPT code 70551 must explain the medical necessity of the MRI scan without contrast. For example, you must document the symptoms, the purpose of the MRI, the reason for a non-contrast MRI, and the procedure’s medical necessity to make the claim valid.
Consider Payer Policies
Before submitting claims for reimbursement, be sure you are aware of your patient’s insurance coverage plan. How and at what rate will your practice be reimbursed by the patient or the local payer? Since each state and payer has different billing policies and reimbursement rules, you must check the manuals for clarity and to ensure clean claim submission.
Append the Appropriate Modifiers
Various modifiers can be appended to CPT code 70551. It is important to understand every modifier. For example, do not append modifier 76 if another technician or physician repeats the MRI scan on the same day. You should be careful while appending modifiers to your claim. Otherwise, it will lead to denials.
Final Thoughts on CPT Code 70551
CPT code 70551 reports a magnetic resonance imaging (MRI) of the brain and brainstem without contrast. It typically identifies or monitors issues such as brain injuries, infections, multiple sclerosis, congenital abnormalities, tumors, and strokes.
Do you work as a medical professional and find it challenging to bill for MRI procedures that need different modifiers? You can count on our professional neurology billing services for a seamless billing process.
