I assume that when magnetic resonance imaging (MRI) of the liver, regardless of the clinical indication, and the other abdominal structures are defined in the report, we should append modifier 52. If I understand the rules correctly, to meet the intent of 74181 all organs must be evaluated, anything less requires modifier 52 depending on the payer.
Unlike ultrasound exams, computed tomography (CT) and MRI do not have specified elements that must be documented. Each exam should be tailored to the individual patient’s need. It is not necessary to image all abdominal organs to code 74181. Only if the doctor documents the exam as a limited exam would you add modifier -52.