You may know that MRI detects neurological conditions, but do you know its specific code? Healthcare providers perform nearly 40 million MRIs in the U.S. annually. Many of these tests focus on the brain and surrounding tissues. The most interesting part is that some assessments include contrast material, while others don’t.
Coding is all about those tiny details! We all know that even a minor difference in a procedure means you have to use a different code to report it. So, how do you bill for a brain MRI with dye? The correct answer is CPT code 70552! Let’s discuss this code in detail.
CPT Code 70552 – Description
CPT code 70552 is quite straightforward, referring to a popular radiology procedure. To be more precise, it specifies a magnetic resonance imaging (MRI) of the brain and brainstem using contrast. So, what exactly is an MRI, and how does a contrast agent help with the assessment? Before that, let’s clarify what the brainstem is.
The brainstem is the lowest part of the brain and includes three sections: midbrain, pons, and medulla oblongata. It acts as an important connecting point between the cerebrum (the largest part of the brain) and the spinal cord. Its primary purpose? Managing vital functions like breathing, heart rate, consciousness, and sleep!
MRI is the ideal procedure to visualize the brain and its structures. This non-invasive procedure uses a magnetic field and radio waves to generate detailed images of the internal tissues and organs on a computer screen. Healthcare providers often perform this test with a contrast agent, also known as contrast dye, to enhance the brain’s visibility, which helps them detect a wider range of problems.
In short, CPT code 70552 covers a more detailed and comprehensive view of the brain.
Scenarios Where CPT Code 70552 is Applicable
Still confused about how to code a brain MRI with contrast? Look at the following three scenarios to understand the correct application of CPT code 70552.
MRI with Contrast to Evaluate the Severity of Brain Trauma
Did you know that approximately 2.5 million cases of traumatic brain injuries (TBIs) occur in the U.S. every year? Of these cases, 50,000 result in death, and 80,000 lead to lifelong disability, according to the Brain Trauma Foundation. The Centers for Disease Control and Prevention (CDC) cite falls as the leading cause of these injuries.
Healthcare providers often use MRI during the acute phase (first 24 hours) of a mild traumatic brain injury (mTBI). So, for our first example, let’s consider a 24-year-old football player with a concussion. He is brought to the emergency department five hours after a fall, after experiencing dizziness.
The doctor consults his teammates and learns that the patient fell and hit his head on the ground after a tackle. To assess the severity of the injury, the physician orders an MRI with contrast. A radiologist performs the test and then reports it using CPT code 70552.
MRI with Contrast to Detect a Brain Tumor
Brain tumors are the 10th leading cause of cancer-related deaths among all genders and age groups. Each year, approximately 94,390 Americans are diagnosed with a primary brain tumor through imaging studies like MRI and CT scans.
Therefore, let’s assume a 36-year-old woman visits a neurology clinic with complaints of persistent headaches, dizziness, and nausea. Upon evaluation, the doctor discovers that she is also experiencing double vision and hearing difficulties.
Suspecting a brain tumor, the neurologist orders a brain MRI with contrast. A radiologist performs the scan and bills it using CPT code 70552.
MRI for Post-Stroke Brain Evaluation
Ischemic strokes are the most common type of stroke and occur when blood flow to the brain is blocked. Can you believe that this type of stroke can kill around 32,000 brain cells within one second and nearly 1.9 million brain cells in just one minute?
Now, consider a 67-year-old woman who develops speech difficulties following a stroke. Her husband brings her to the nearest hospital for evaluation. After an initial assessment, the neurologist orders an MRI with contrast to determine the extent of brain damage.
A radiologist performs the scan using a gadolinium-based contrast agent and then uses CPT code 70552 to report his role.
Applicable Modifiers for CPT Code 70552
Don’t give insurance companies any reason to deny your claims. Use the following modifiers with CPT code 70552 to provide the appropriate context based on the situation:
Modifier TC
Apply modifier TC to CPT code 70552 when reporting only the technical component of the MRI — that is, performing the test without interpretation. In simpler terms, hospitals and imaging facilities typically use this modifier to indicate the use of equipment, supplies, and the involvement of non-physician medical staff.
Modifier 26
Use modifier 26 if you are only interpreting the MRI results. For example, a radiologist working in a hospital or outpatient imaging center may append this modifier to report their professional role in the diagnostic process.
Modifier 59
Did you perform other services on the same patient during the same visit? Use modifier 59 with CPT code 70552 if the MRI with contrast is distinct and unrelated to those additional services.
Modifier 76
Append modifier 76 to CPT code 70552 if the same radiologist repeated the MRI with contrast on the same patient on the same day.
Modifier 77
What if a different radiologist repeated the MRI with contrast on the same patient on the same day? In that case, apply modifier 77 to CPT code 70552.
CPT Code 70552 – Billing & Reimbursement Guidelines
Want to avoid common billing errors associated with CPT code 70552? Follow these guidelines:
Use Code 70552 Only for MRIs with Contrast
Let us reiterate that some imaging studies are performed with contrast, while healthcare providers conduct others without it. The decision depends on the patient’s condition and symptoms. Therefore, only report CPT code 70552 for brain MRIs with contrast.
Otherwise, you might face claim denials or underpayment by insurance companies.
Document the Medical Necessity of MRI with Contrast
You must provide clinical justification for performing an MRI with contrast. Therefore, your patient’s medical record should include the following details:
- Presenting symptoms
- Relevant medical condition
- A confirmed diagnosis with the appropriate ICD-10 code (e.g., S06.0 for concussion, C71.9 for an unspecified brain tumor)
This documentation will support the medical necessity of CPT code 70552. Additionally, clearly indicate that you used a contrast agent during the procedure to enhance the images of specific brain structures. Want to know how? Include details such as contrast agent type, dosage, timing, and any observed reactions.
Append Appropriate Modifiers (If Necessary)
Want to provide additional billing context? Use the appropriate modifiers with CPT code 70552. You can refer to the previous section to see which modifiers apply in specific situations.
Check Payer Policies and Coverage Requirements
Always verify the billing guidelines and coverage criteria of the patient’s insurance payer before submitting a claim. Pay special attention to payer-specific rules for CPT code 70552, including Medicare’s coverage policy.
For example, Medicare does not cover MRIs for patients with metallic clips used in vascular aneurysm repair. One more tip! Be prepared to submit clinical documentation and MRI reports upon request from the insurance company.
Summary
So, are you ready to code imaging studies for the brain? Or are you still a little lost? To summarize, CPT code 70552 covers contrast-based brain MRI, a necessary test to diagnose brain cancer, injuries, damage, and degenerative diseases.
We understand that billing for radiology procedures can get messy, especially with frequent coding updates. Therefore, we have tried to simplify CPT code 70552 as much as possible so you don’t confuse it with other similar codes like 70551 and 70553.To help you avoid denials, we highlighted three specific scenarios for CPT code 70552 and even provided a list of applicable modifiers. Level up your coding accuracy with our guide! However, you can also opt for third-party neurology billing services to free up your time.
