Radiology billing is trickier than other specialties. It requires attention to detail, several documents, and prior authorizations. In short, it is hard to bill, and many billers face denials for their claims.
A frequently used code in radiology billing is CPT code 72148. This code is particularly challenging to bill. Why? Because of its extensive documentation requirements and the conditions imposed by Medicare for its use.
So, how can you use it for billing? Well, that is what this blog is all about. Our billing experts at MediBillMD have compiled this comprehensive guide on CPT code 72148 to answer all your questions. So, let’s start.
CPT Code 72148 – Description
Before we discuss the billing requirements, you must understand what CPT code 72148 refers to. 72148 is used to bill magnetic resonance imaging (MRI) of the lumbar spinal canal and its contents without the use of contrast material.
That is quite a mouthful, so let us break this down in simpler terms.
Magnetic Resonance Imaging, simply known as MRI, utilizes powerful magnetic fields and radio waves to create detailed, high-resolution images of the lower spine, including the vertebrae, intervertebral discs, spinal cord, nerve roots, and surrounding soft tissues.
CPT code 72148 is specifically used for the imaging of the lumbar region. You might ask how the lumber region is identified. Well, it encompasses the five lumbar vertebrae (L1-L5) and the lumbosacral junction.
Additionally, unlike the MRI procedures that require contrast enhancement, 72148 is exclusively for imaging without contrast. So, gadolinium or other contrast agents are not injected into the veins for this procedure.
Scenarios Where CPT Code 72148 is Applicable
Now, let’s look at a couple of applicable scenarios for CPT code 72148:
Chronic Lower Back Pain
Suppose a patient comes to the physician and complains of persistent pain in his lower back. As a base treatment, the physician prescribes some conservative pain management techniques and painkillers. However, even after four weeks of medication, the pain remains. This indicates some serious underlying issues. To diagnose it, the physician orders an MRI of the lower back.
The imaging study helps differentiate between various causes of lower back pain, including disc herniation, spinal stenosis, facet joint arthropathy, and degenerative disc disease. The biller can bill the procedure with CPT code 72148.
Pre-Surgical Planning
If a patient requires lower back surgery, the surgeon cannot perform the procedure based on intuition. He needs exact details of the entire region to successfully perform the surgery without harming the surrounding tissues and organs.
CPT code 72148 provides crucial information for pre-operative planning for patients being considered for lumbar spine surgery. The detailed imaging from the MRI helps surgeons plan the extent and depth of the surgery.
Applicable Modifiers for CPT Code 72148
The following are some of the modifiers that you can use with CPT code 72148 based on the situation.
| Modifier | Description | Usage |
|---|---|---|
| 26 | Professional Component | When the physician only interprets the MRI results and reports them. |
| TC | Technical Component | When the radiology facility performs the test. Used to bill for the equipment and the technician’s time. |
| 52 | Reduced Services | Used when the MRI procedure was partially reduced or eliminated. |
| 53 | Discontinued Procedure | Used when the MRI procedure was started but discontinued after anesthesia administration. |
| 59 | Distinct Procedural Service | Used when MRI was a distinct service from other procedures performed on the same day. |
| 76 | Repeat Procedure by Same Physician | When the same physician repeats the lumbar MRI on the same day. |
| 77 | Repeat Procedure by Another Physician | When another physician repeats the lumbar MRI on the same day. |
CPT Code 72148 – Billing & Reimbursement Guidelines
Was your claim for CPT code 72148 denied due to a lack of medical necessity or any other reason? Here is how you can bill it accurately:
Coverage and Documentation Requirements
Medicare coverage of CPT code 72148 is conditional. What does it mean? Medicare covers this code when the procedure meets established medical necessity criteria and is supported by appropriate clinical documentation. Your medical records must clearly demonstrate the clinical rationale for performing the MRI study, including relevant patient history, physical examination findings, and prior treatment attempts.
Another important condition that some payers impose for code 72148 is that, for non-emergent conditions, patients must have received at least four weeks of conservative treatment before an MRI is considered medically necessary.
Reimbursement Rates
The reimbursement amount for CPT code 72148 varies greatly based on location and facility settings. The national average Medicare reimbursement for 72148 is $188.26 for non-facility settings. For facility settings, the exact price data is not available.
To check the exact reimbursement amount for your MAC locality, you can use Medicare’s PFS Lookup Tool.
Pre-Authorization
Many healthcare providers need the payer’s prior approval for a lumbar spinal canal MRI (CPT code 72148) and other diagnostic radiology procedures. The pre-authorization process typically involves submitting the patient’s clinical information, including symptoms, duration of complaints, prior treatments attempted, physical examination findings, and specific clinical questions that the MRI study will address.
If you don’t get the procedure approved before providing the service, your claim will be denied. So, ask the insurance payer if a prior authorization is necessary. If it is, obtain it to avoid denials for CPT 72148 claims. Also, ask the payer if there are any other billing requirements.
Wrapping Up
Stop giving payers a chance to deny your claims with inaccurate coding. In this blog, we have covered everything you need to know to submit CPT code 72148 successfully. However, if you have already forgotten the important points, let’s do a quick recap.
- 72148 is a diagnostic MRI code for the lumbar area without contrast.
- The patient must have received 4 weeks of conservative treatment before the MRI.
- Appending the correct modifiers (when needed) and documentation is essential.
In short, you can receive proper reimbursements for CPT code 72148 if you follow our billing guidelines. But if you want professional help, you can choose our radiology billing services to maximize your revenue.
