Neurology is a complex specialty, and billing for its related procedures is equally complicated. Magnetic Resonance Imaging (MRI) is an essential diagnostic procedure that neurologists often leverage to evaluate a patient’s condition. This guide will cover everything you need to know about billing the CPT code 70553, i.e., an MRI service-related code.
It is essential to have a nuanced understanding of this procedural code to ensure accurate claim submission and timely reimbursement. Any error in the billing procedure may lead to payment delays and denials, ultimately straining your neurology practice’s revenue cycle.
Thus, read this guide till the end if you want a steady cash flow!
CPT Code 70553 – Description
CPT code 70553 is from the ‘Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck’ and is maintained by the American Medical Association (AMA).
It covers the MRI study of the brain and the brainstem first without contrast, and then after administering the contrast material.
Scenarios Where CPT Code 70553 is Applicable
Here are some clinical scenarios where the physician may require non-contrast MRI images followed by contrasted MRI images of the brain and the brainstem:
Vertigo and Ataxia Investigation
Picture a 60-year-old male patient with new and progressive symptoms of severe vertigo, incoordination, and imbalance. The initial neurological examination reveals nystagmus and ataxia. Therefore, the neurologist orders an MRI of the brain and brainstem with and without contrast (CPT code 70553).
The non-contrast imaging study enables the neurologist to rule out large structural lesions or acute stroke. On the other hand, the images with contrast help to better delineate any smaller tumors in the cerebellopontine angle or brainstem.
New-Onset Seizures Evaluation
Imagine a 48-year-old male patient who visits the neurology clinic. He complains about a new onset of generalized tonic-clonic seizures. The neurologist orders an initial neurological exam, but it is unremarkable between episodes. Therefore, the neurologist orders an MRI of the brain and brainstem with and without contrast (CPT code 70553).
The non-contrast and contrast images help the neurologist investigate potential underlying structural abnormalities.
Progressive Cranial Nerve Deficits Assessment
Suppose a 45-year-old female patient with a gradual onset of facial weakness and double vision visits the clinic. The physician suspects a lesion affecting the cranial nerves, possibly within the brainstem. Therefore, he orders an MRI with and without contrast (CPT code 70553).
The initial non-contrast images reveal any masses or structural changes. Contrarily, the contrast images visualize potential tumors, such as meningiomas or neuromas, demyelinating lesions, or inflammatory processes, like sarcoidosis.
Applicable Modifiers for CPT Code 70553
Discussed below are all applicable modifiers for CPT 70553:
Modifier TC
Are you a hospital or imaging facility that wants to bill for the technical component of CPT code 70553? If yes, append modifier TC. This indicates to the payer that you are billing for the equipment, supplies, and services of non-physician professionals without interpreting the images.
Modifier 26
Healthcare providers use this modifier to highlight to the payer that they are billing only for the professional component of the CPT code 70553. That is, they interpreted the images and prepared the report, but did not own the equipment.
Modifier 59
What happens when you perform the brain MRI covered under CPT code 70553 with other procedures during the same visit? You append modifier 59 to indicate that the MRI is a distinct and significant procedure, eligible for a separate reimbursement. It is an essential modifier that prevents payment cuts due to unnecessary bundling of services.
Modifier 76
Append modifier 76 to CPT code 70553 when the same physician repeats the MRI with and without contrast on the same day. It identifies that the repetition was clinically necessary and steers you clear of denials due to duplication error.
Modifier 77
Use modifier 77 if the non-contrast and contrast imaging studies covered under CPT code 70553 are repeated by another physician on the same day.
CPT Code 70553 – Billing & Reimbursement Guidelines
The following are the billing and reimbursement guidelines for CPT 70553:
Bill CPT 70553 for Non-Contrast MRI Followed by Contrast MRI
Just remember, coding accuracy is the rule of thumb when billing any medical service. You should always report CPT code 70553 when the physician orders non-contrast brain and brainstem images, followed by a contrast MRI during the same session.
Avoid reporting MRI without contrast (70551) and MRI with contrast (70552) separately when performed in the same session. Doing so will lead to claim denials, audits, and penalties.
Appropriately Append Modifiers
The use of appropriate modifiers allows coding specificity. Simply put, it enables you to provide additional details to the payer so you can receive fair reimbursement. Some modifiers that apply to CPT 70553 are TC, 26, 59, 76, and 77.
You can find more on these modifiers in the ‘Applicable Modifiers for CPT Code 70553’ section.
Focus on Adequate Documentation
Documentation completeness and accuracy are vital to support the medical necessity of brain and brainstem MRI with and without contrast. Therefore, you should include the following in your documentation:
- Date of service.
- Clinical indication for ordering the non-contrast MRI followed by a contrast MRI during the same session.
- Patient’s medical history.
- Contrast and non-contrast images.
- Written and signed report on the interpretation of contrast and non-contrast images.
- The type and amount of contrast material administered to the patient.
Summary
With that said, it is time to wrap up this detailed guide. However, before concluding, let’s review what we learned!
First, we explained the CPT code 70553 descriptor. It covers the non-contrast MRI followed by contrasted imaging after administering the contrast material in the same session.
We also shared some clinical scenarios where this CPT code applies. These include progressive cranial nerve deficits assessment, new-onset seizures evaluation, and vertigo and ataxia investigation.
Next, we discussed which modifiers can apply to CPT 70553 in different scenarios. These include TC, 26, 59, 76, and 77.
Finally, we looked into the billing and reimbursement guidelines.
These details are enough to master the accurate billing for CPT 70553. However, if you don’t have an in-house certified professional coder (CPC), you may struggle to receive timely reimbursements. Therefore, we recommend outsourcing neurology billing services to professionals like MediBillMD.
