Are you confident that your practice is getting the maximum possible reimbursement for the radiology claims? Probably not. Because 38% of the healthcare providers claim that every 1 in 10 claims is denied, this includes radiology service claims.
Medical imaging procedures, like magnetic resonance imaging (MRI), form the backbone of accurate diagnosis in modern healthcare. Without these, physicians cannot perform critical operations or even diagnose fatal diseases.
CPT code 73721 is a vital imaging code that is frequently used in radiology billing. However, as a healthcare provider, how can you maximize reimbursement for this code and avoid denials? That’s what we are going to discuss in this blog. So, let’s start.
CPT Code 73721 – Description
The official definition of CPT code 73721 is:
“Magnetic resonance (e.g., proton) imaging, any joint of the lower extremity, without contrast material.”
Sounds hard? Let’s break this down in simpler words.
CPT code 73721 bills an MRI procedure that is performed to view the lower body joints, like the hip, knee, ankle, and foot joints. A distinguishing feature of 73721 is that it is performed without contrast dye.
When a physician orders an MRI without contrast, it means the dye is not injected into the patient’s veins to highlight joints, surrounding structures, and blood vessels.
You might be wondering exactly what happens during the MRI. Here’s a brief description.
The procedure involves the patient lying on a motorized table that slides into the MRI machine. Powerful magnetic fields and radio waves create detailed cross-sectional images of the joint structures, including bones, cartilage, ligaments, tendons, and surrounding soft tissues. The entire process typically takes 30-60 minutes.
Scenarios Where CPT Code 73721 is Applicable
To make things simple, here are some real-world scenarios where CPT code 73721 can be used.
Joint Pain Evaluation
When patients present with persistent or severe joint pain in the lower extremities, MRI without contrast provides comprehensive visualization of all joint structures, helping diagnose the underlying issue. In this case, the biller can use CPT code 73721 for each examined joint.
Ligament and Tendon Injuries
Road accidents are common and result in significant injuries. Oftentimes, these injuries penetrate deep and damage the joint ligaments and tendons. To properly treat these injuries, physicians require a detailed scan of the affected area and assess the extent of damage.
MRI excels at visualizing soft tissue structures, making it the preferred imaging modality for evaluating suspected tears or partial injuries to ligaments and tendons. So, if a physician orders an MRI, the biller can use one unit of CPT code 73721 for every joint.
Applicable Modifiers for CPT Code 73721
The following are some of the most frequently used modifiers with CPT code 73721:
| Modifier | Description | Usage |
|---|---|---|
| 26 | Professional Component | Used when billing only for the interpretation and reporting of MRI results. |
| 50 | Bilateral Procedure | Used when both left and right lower extremity joints are scanned in one session. For example, the left and right ankles. (Rare for MRIs). |
| 52 | Reduced Services | Used when the service is partially reduced or eliminated, e.g., when the full MRI protocol cannot be completed as planned. |
| 53 | Discontinued Procedure | Used when the procedure is stopped due to patient safety concerns, e.g., when the procedure must be terminated for patient well-being. However, the procedure must have been terminated after anesthesia administration. |
| 59 | Distinct Procedural Service | Indicates the procedure was distinct from other services performed on the same day, e.g., when multiple imaging studies need separate reporting. |
| 76 | Repeat Procedure by Same Physician | Used when the same physician repeats the procedure on the same day, e.g., to obtain subsequent images. |
| 77 | Repeat Procedure by Another Physician | Used when a different physician repeats the procedure on the same day. |
| LT | Left Side | Used if the MRI scans a left lower extremity joint. |
| RT | Right Side | Used if the MRI scans a right lower extremity joint. |
| TC | Technical Component | Used when the facility seeks payment for the equipment and the staff running the MRI machine. |
Please note that CPT code 73721 is not bilateral. It means that if the MRI is performed on both legs, you will have to use the modifier 50, or LT/RT, in case only one side is examined. However, Medicare will not reimburse the bilateral procedures at 100% each because the Bilateral Surgery Status Indicator for CPT code 73721 is ‘3’. Hence, the usual payment adjustments for bilateral procedures do not apply.
Additionally, 73721 is billed for each joint. For example, if the physician orders an MRI scan of the hip and knee joint of the same leg, you will have to bill the procedure twice. OR, use modifier 59 to indicate distinct procedures (depending on the insurance payer’s billing rules).
CPT Code 73721 – Billing & Reimbursement Guidelines
The following billing best practices and guidelines will help you avoid claim denials for a lower extremity joint MRI, without contrast (CPT code 73721).
Provide Supporting Documentation
Appending the necessary documentation with CPT code 73721 claims is vital to justify the medical necessity. The medical records must contain specific clinical indications or symptoms for the MRI procedure, such as consistent joint pain or ligament tears.
This should be supported with the patient’s relevant medical history and the diagnostic question that the imaging study is intended to answer. Plus, the records must also clearly specify the joint or region being examined.
Obtain Prior Authorization
Many insurance payers mandate prior authorization for MRI procedures, including those billed under CPT code 73721. So, before providing any services, you must get pre-authorization from the patient’s insurance payer to avoid denials later on.
Confirm the Reimbursement Amount
The reimbursement amount for CPT code 73721 varies based on location and facility settings. The national average Medicare reimbursement for 73721 is $200.22 for non-facility settings. For facility settings, the exact price data is not available.
To check the exact amount for your MAC locality, you can use Medicare’s PFS Lookup Tool.
Wrapping Up
With that said, let’s wrap up this guide! In this blog, we have explained in detail what CPT code 73721 is, what modifiers you can use in your claims, and how to bill it correctly. By following the guidelines that we mentioned, you can avoid denials for 73721 and boost your revenue. Here is a quick recap of the features of 73721:
- Procedure Type: Non-invasive diagnostic imaging
- Anatomical Focus: Lower extremity joints (hip, knee, ankle, foot)
- Contrast Status: Without contrast material
- Imaging Technology: Magnetic resonance imaging using magnetic fields and radio waves
However, if you still find it challenging to handle medical coding and billing in-house, we recommend exploring professional radiology billing services offered by third-party billing companies.
