Medical necessity considerations and coding requirements for MRI sequences
We have a radiologist who wanted to perform seven series of a magnetic resonance (e.g., proton) imaging, any joint of upper extremity; without contrast material(s), CPT® code 73221. During this scan, only three were performed, two were hampered by patient motion, so only one sequence was clear to read.
Am I correct that MRI code descriptions do not state required elements or a required number of sequences? As such, they should be tailored to the medical need of the patient. Therefore, it would not be necessary to add a reduction (-52) modifier? Are there any scenarios in which the series were too incomplete and additional scanning must be performed on a different day that would constitute the original charge to have the -52 modifier appended?
You are correct that there are no required number of sequences, or images, for an MRI. They should be tailored to the medical necessity of the patient. That said, if the physician documents it as a “limited” exam, or if they specify that most were unreadable, etc., then we would recommend coding these as limited, especially if you are going to bring the patient back to re-do the exam.