Medical Billing When There Isn’t An Exact CPT Code

Certain areas of the body do not have CPT codes for procedures, such as an MRI done on a hip of a patient. You need to use the codes 73721-73723 (Magnetic resonance imaging, any joint of lower extremity). The hip joint falls into this medical billing category because it is a lower extremity joint.

Doing medical billing for bilateral hip MRIs is also a bit more complicated. Different payers require different modifiers for payment. For example, Medicare prefers that bilateral MRIs be reported with LT (Left side), and RT (Right side), along with the medical billing modifier 76 (Repeat procedure by same physician). You should check with the various payers to see what medical billing method they prefer because some like to keep things simple. Some payers merely require modifier 50 (Bilateral procedure).

A common misconception in the MRI medical billing world is the reporting of a pelvis MI. When your practice performs an MRI of the hip, only use the lower extremity joint MRI codes. Do not use medical billing codes 72195-72197 (Magnetic resonance imaging, pelvis). This is a very common medical billing error and will cause your claim to many times be denied.

When performing an MRI on both the hip and knee joints, it is usually permissible to bill separately for each. An MRI machine is set up to take images of specific parts of the human body. If different parts are x-rayed you can usually code separate claims.

View all Articles by: Melissa Clark, CCS-P