Question:

We are beginning to perform abbreviated breast screening magnetic resonance imaging (MRI) scans without and with/without contrast. They have fewer sequences and take about half the amount of time of a regular breast MRI. If done without contrast followed by contrast administration and imaging, would we report CPT® code 77049-52 or an unlisted CPT code?

Answer:

MRI code descriptions do not state the required elements or a required number of sequences. As such, they should be tailored to the medical need of the patient. Therefore, it is not necessary to add modifier 52 to the appropriate CPT® code. Report CPT code 77049 if a bilateral exam is performed, or CPT code 77048 if a unilateral exam is performed. If billing for the outpatient hospital under OPPS, report code C8905 for a unilateral exam, or C8908 for a bilateral exam. In addition, report the appropriate HCPCS code for the contrast material used as well. As a screening exam, the diagnosis code submitted should be Z12.39.

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