Wednesday, August 11, 2010

BILLING code for MRA of head, neck ,chest and pelvis

Providers must report HCPCS codes when submitting claims for MRA of the chest, abdomen, head, neck or peripheral vessels of lower extremities. The following HCPCS codes should be used to report these services:

MRA of head 70544, 70544-26, 70544-TC
MRA of head 70545, 70545-26, 70545-TC
MRA of head 70546, 70546-26, 70546-TC
MRA of neck 70547, 70547-26, 70547-TC
MRA of neck 70548, 70548-26, 70548-TC
MRA of neck 70549, 70549-26, 70549-TC
MRA of chest 71555, 71555-26, 71555-TC
MRA of pelvis 72198, 72198-26, 72198-TC
MRA of abdomen (dates of service on or after July 1, 2003) – see below. 74185, 74185-26, 74185-TC
MRA of peripheral vessels of lower extremities 73725, 73725-26, 73725-TC

Hospitals subject to OPPS should report the following C codes in place of the above HCPCS codes as follows:

• MRA of chest 71555: C8909 – C8911
• MRA of abdomen 74185: C8900 – C8902
• MRA of peripheral vessels of lower extremities 73725: C8912 – C8914

For claims with dates of service on or after July 1, 2003, coverage under this benefit has been expanded for the use of MRA for diagnosing pathology in the renal or aortoiliac arteries. The following HCPCS code should be used to report this expanded coverage of MRA:

• MRA, pelvis, with or without contrast material(s) 72198, 72198-26, 72198-TC
Hospitals subject to OPPS report the following C codes in place of HCPCS code 72198:

• MRA, pelvis, with or without contrast material(s) 72198: C8918 - C8920

NOTE: Information regarding the claim form locator that corresponds to the HCPCS code and a table to crosswalk its CMS-1450 form locator to the 837 transaction is found in Chapter 25.


INDICATIONS FOR CHEST CTA:

For evaluation of suspected or known pulmonary embolism (excludes low risk*).

For evaluation of suspected or known vascular abnormalities:

* For evaluation of a thoracic/thoracoabdominal aneurysm or dissection (documentation of clinical history may include hypertension and reported “tearing or ripping type” chest pain.
* Congenital thoracic vascular anomaly, (e.g., coarctation of the aorta or evaluation of a vascular ring suggested by GI study).
* Signs or symptoms of vascular insufficiency of the neck or arms (e.g., subclavian steal syndrome with abnormal ultrasound).
* Follow-up evaluation of progressive vascular disease when new signs or symptoms are present.
* Pulmonary hypertension.

Preoperative evaluation

* Known vascular abnormalities and patient has not had a catheter angiogram within the last month.
* Proposed ablation procedure for atrial fibrillation.

Postoperative or post-procedural evaluation

* Known vascular abnormalities with physical evidence of post-operative bleeding complication or re-stenosis.

* Request for a follow-up study - A follow-up study may be needed to help evaluate a patient’s progress after treatment, procedure, intervention or surgery. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested.

INDICATIONS FOR CHEST MRA:

For evaluation of suspicious mass and CTA is contraindicated due to a history of contrast allergy or high risk for contrast induced renal failure.

For evaluation of suspected or known pulmonary embolism (excludes low risk*).

For evaluation of suspected or known vascular abnormalities:

* For evaluation of a thoracic/thoracoabdominal aneurysm or dissection (documentation of clinical history may include hypertension and reported “tearing or ripping type” chest pain.
* Congenital thoracic vascular anomaly, (e.g., coarctation of the aorta or evaluation of a vascular ring suggested by GI study).
* Signs or symptoms of vascular insufficiency of the neck or arms (e.g., subclavian steal syndrome with abnormal ultrasound).
* Follow-up evaluation of progressive vascular disease when new signs or symptoms are present.
* Pulmonary hypertension.

Preoperative evaluation

* Known vascular abnormalities and patient has not had a catheter angiogram within the last month.
* Proposed ablation procedure for atrial fibrillation.

Postoperative or post-procedural evaluation

* Known vascular abnormalities with physical evidence of post-operative bleeding complication or re-stenosis.

* Request for a follow-up study - A follow-up study may be needed to help evaluate a patient’s progress after treatment, procedure, intervention or surgery. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested.

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