CPT code 70551 is for an MRI of the brain stem performed without contrast dye, used to diagnose conditions affecting this critical area.
CPT code 70551 is used to describe an MRI (Magnetic Resonance Imaging) procedure of the brain stem performed without the use of contrast dye. This imaging technique is utilized to produce detailed images of the brain stem, which is the part of the brain that connects to the spinal cord, and is crucial for controlling many basic life functions. The absence of contrast dye means that the procedure does not involve the injection of a special dye into the patient's bloodstream to enhance the visibility of certain structures or abnormalities. This code is typically used for diagnostic purposes to assess conditions such as tumors, brain stem lesions, or other neurological disorders.
When dealing with CPT codes for MRI and MRA procedures, it's important to consider the appropriate use of modifiers to ensure accurate billing and reimbursement. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when the professional component of the service is being billed separately from the technical component. It is applicable when the radiologist provides only the interpretation of the MRI or MRA images.
2. Modifier TC (Technical Component): This modifier is used when the technical component of the service is being billed separately. It applies when the facility provides the equipment, supplies, and technical staff for the MRI or MRA procedure.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is applicable when multiple procedures are performed that are not typically reported together.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can sometimes be applicable in radiology when a test is repeated for clinical reasons.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required.
These modifiers help in accurately reflecting the nature of the service provided and ensure proper reimbursement. It's crucial to apply them correctly based on the specific circumstances of each procedure.
The CPT code 70551 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates and policies for this code can vary depending on the specific region and the Medicare Administrative Contractor (MAC) responsible for that area.
Each MAC may have different local coverage determinations (LCDs) that can affect the reimbursement process. Therefore, healthcare providers should consult their respective MAC for detailed information on the reimbursement specifics and any documentation requirements that may apply to CPT code 70551.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 70551, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and optimize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
