Neurosurgery coding? It’s a beast. Even seasoned coders get tangled up in the details. And if you are a neurosurgeon trying to keep your practice afloat, you know how tough it is to juggle patient care and billing. CPT code 70551 might seem simple, but get it wrong, and reimbursements take a hit. This guide breaks down everything you need to know to code it right every time.
So, without further ado, let’s jump right into the details!
CPT Code 70551 – Description
The CPT code 70551 is from the code range ‘Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck’ and is maintained by the American Medical Association (AMA). It indicates magnetic resonance imaging (MRI) of the brain and brainstem without contrast.
Scenarios Where CPT Code 70551 is Applicable
Here, take a look into some practical scenarios where the CPT code 70551 applies:
MS Screening
Imagine: A patient comes in with ongoing visual disturbances and numbness/tingling. The healthcare professional suspects early-stage multiple sclerosis (MS) and orders an initial MRI.
The MRI without contrast will help reveal any diagnostic lesions. Thus, CPT code 70551 applies. But, if needed, the physician might order an MRI with contrast.
Chronic Headaches Evaluation
Picture this: A patient with chronic, non-specific headaches visits the clinic. He also mentions the headaches are getting worse, more intense, and more frequent. His neurological exam is mostly normal, but the physician wants to rule out structural issues.
So, the physician orders an initial MRI without contrast to check for causes of the chronic headaches. Why an MRI without contrast? The provider does not strongly suspect a tumor, infection, or vascular malformation that would need contrast. Thus, CPT code 70551 applies.
Post-Concussion Syndrome Assessment
Suppose: A patient sustained a mild traumatic brain injury several weeks ago. However, he continues to experience persistent symptoms, such as cognitive difficulties, dizziness, and headaches. So, the physician orders an MRI to check for any structural damage.
Typically, for post-concussion syndrome, an MRI without contrast is enough to look for structural problems. Thus, CPT code 70551 applies.
Applicable Modifiers for CPT Code 70551
The following are the applicable modifiers for CPT 70551:
Modifier 26
Append the modifier 26 when you have only interpreted the MRI test results and prepared a report. This modifier indicates that you are billing for the professional component of CPT code 70551.
Modifier TC
Use the modifier TC with CPT 70551 if you want to bill solely for the technical component. It covers supplies, equipment, personnel, and the technician’s time.
Modifier 59
The modifier 59 highlights that the MRI procedure is distinct and separately identifiable from other services rendered on the same day. Typically, this modifier is applicable in scenarios where multiple services are provided that are generally not reported together.
Modifier 76
Was the MRI procedure repeated by the same physician on the same day? If yes! Append modifier 76 to the CPT code 70551. It will help you avoid denial due to duplication errors.
Modifier 77
Modifier 77 applies when the MRI is repeated by a different healthcare provider on the same day.
Modifier 91
Modifier 91 is more common for laboratory tests. However, it may apply to the CPT 70551 when service repetition is necessary for clinical reasons.
Modifier 52
What happens when the MRI is partially reduced or discontinued at the physician’s discretion? You apply modifier 52 with the CPT code 70551 to ensure coding specificity and fair reimbursement.
Modifier 53
Sometimes, a procedure is terminated due to unforeseen circumstances beyond the physician’s control, such as a threat to the patient’s well-being. When such a situation arises, use modifier 53 with the CPT code 70551.
Modifier 22
It indicates increased procedural service. Simply put, append the modifier 22 when the MRI took significantly more time, resources, and effort than typically required.
CPT Code 70551 vs. 70553
Below is an at-a-glance table comparing the two CPT codes 70551 and 70553:
| CPT Code 70551 | CPT Code 70553 | |
|---|---|---|
| Description | MRI of the brain and brainstem, without contrast material. | MRI of the brain and brainstem. First without contrast material, then with contrast material. |
| Contrast Administration Included | No | Yes |
| Clinical Indication | For screening, initial evaluations of headache, and stable lesion. | For further evaluation that requires contrast enhancement to identify or characterize lesions. |
| Time and Cost | Shorter time and lower cost. | Longer time and higher cost. |
CPT code 70551 covers an MRI of the brain and brainstem without contrast. Alternatively, CPT code 70553 involves an MRI of the brain and brainstem, first without contrast and then with contrast. Therefore, the main distinction between these codes is contrast administration.
Now, let’s talk about the clinical indication of these CPT codes!
Physicians typically order CPT code 70551 for initial evaluations, screening, or when contrast administration is contraindicated. Under this code, technicians capture images of brain structure without contrast enhancement.
However, for CPT code 70553, technicians acquire non-contrast images for a baseline view of the brain structure. They then inject a contrast agent (gadolinium-based dye) and take additional pictures. This enhances the visibility of specific tissues or lesions, allowing for more detailed assessment and differentiation. Physicians order this exam for:
- Further characterization of abnormalities
- The suspicion of pathologies, i.e., best visualized with contrast enhancement.
CPT Code 70551 – Billing & Reimbursement Guidelines
Discussed below are the CPT code 70551 billing and reimbursement guidelines:
Establish Medical Necessity
You should demonstrate the medical necessity of the MRI without contrast (CPT code 70551) for reimbursement. It is a standard requirement across all insurance payers for all procedures.
Therefore, documentation must include a valid clinical reason for the MRI. Include the patient’s medical history, symptoms, and the physician’s rationale for ordering the MRI.
Additionally, do not forget to link the ICD-10 diagnosis code with the procedural code to establish medical necessity.
Understand Payer-Specific Policies
Billing and reimbursement guidelines vary significantly across payers. Therefore, always begin by verifying patient insurance coverage and obtaining a pre-authorization.
Besides, review local coverage determinations (LCDs) and payer-specific policies. It will help you acquire detailed information on documentation requirements and reimbursement rates for the CPT code 70551.
For the unversed, LCDs offer guidance on whether a particular procedure or service is deemed medically necessary and eligible for reimbursement.
Focus on Documentation Completeness
Comprehensive documentation is another essential billing requirement of the CPT code 70551. Thus, your claim must include patient demographics and identification, clinical indication for the service, and a detailed description of how you performed the MRI.
Moreover, remember to attach the MRI images, the radiologist’s interpretation, and the written report. All these details are necessary to support reimbursement.
Use Appropriate Modifiers
Certain situations demand modifiers to ensure coding specificity and fair reimbursement. CPT 70551 is a global procedure encompassing both technical and professional components. Therefore, append modifier 26 to bill for the interpretation only. Contrarily, you may use modifier TC to bill for the technician’s time and equipment.
Additional modifiers applicable to the MRI procedure include 22, 52, 53, 59, 76, 77, and 91. Refer to the ‘Applicable Modifiers for CPT Code 70551’ section for details.
Summary
We have covered a lot, haven’t we? So, let’s just run through everything we have learned in this guide! We explained that the CPT code 70551 reports the MRI of the brain and brainstem without contrast for screening and initial evaluations. Besides, we shared some practical scenarios where the physician may order the MRI without contrast. These include multiple sclerosis screening, chronic headache evaluation, and post-concussion syndrome assessment.
Moving forward, we listed all the applicable modifiers, including modifiers 22, 26, 52, 53, 59, 76, 77, 91, and TC. Furthermore, we presented a comparative analysis of the CPT codes 70551 and 70553.Finally, we discussed the billing and reimbursement guidelines for CPT code 70551. These guidelines will assist you in securing timely reimbursements. For assistance with complex medical coding, consider outsourcing neurosurgery billing services to professionals at MediBillMD.
