Better Medical Billing For MRI Claims

Medical billing hip MRI rules are not as straightforward as you might assume. There are many variations on how to correcting bill for this service. There are some facts you should keep in mind when doing medical billing for lower extremity MRIs.

Unfortunately, there is no specific medical billing CPT code for an MRI of the hip. 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). Many people make this medical billing error.

When performing an MRI on both the hip and knee joints, do not be afraid 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 then more work is involved. You medical billing should reflect this. Make sure that your documentation shows a run through of the steps necessary and also the reason for the MRI; this will further enable the carrier to see that the procedure was necessary for diagnostic purposes and more likely to be reimbursed.

View all Articles by: Kathryn Etienne, CCS-P