CPT code 72148, 72149 & 72158 : Superb Coding tips

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Basics about CPT code 72148, 72149 & 72158 for MRI lumbar

Magnetic resonance imaging (MRI) is a radiation-free, noninvasive, technique to produce high quality sectional images of the inside of the body in multiple planes. MRI Lumbar spine procedure (CPT code 72148, 72149 & 72158)  uses the natural magnetic properties of the hydrogen atoms in our bodies that emit radiofrequency signals when exposed to radio waves within a strong electro-magnetic field.

These signals are processed and converted by the computer into high-resolution, three-dimensional, tomographic images. Patients with metallic or electronic implants or foreign bodies cannot be exposed to MRI. The patient must remain still while lying on a motorized table within the large, circular MRI tunnel. A sedative may be administered as well as contrast material for image enhancement.

Read also: Coding Guide for Twin Pregnancy CPT codes

Description of CPT code 72148, 72149 & 72158 (MRI Lumbar)

MRI scan for Lumbar spine is done very frequently in radiology. There are common signs and symptoms for performing MRI exam of lumbar spine like Lumbago or low back pain (724.2), Lumbar radiculitis, back pain etc. The main diagnosis found during MRI lumbar spine is Tear or sprain. Since, MRI procedure always looks for any abnormality in muscles, soft tissue, cartilages and ligaments, it is easy to find any sprain or tear at point of spinal canal. CPT code for MRI lumbar spine is performed without contrast, with contrast and without & with contrast. The oral contrast is always considered as without contrast. Hence, whenever Intravenous contrast is used it is only considered as with contrast. So, there are three separate CPT codes for MRI lumbar spine. Below are three CPT codes used for MRI lumbar spine

72148 – Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material

72149 –  ; with contrast material(s)

72156 – Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; Lumbar

RVUs
72148 – 1.48
72149 – 1.78
72158 – 2.29

Common diagnosis with CPT code 72148, 72149 and 72158

Coming to the diagnosis which supports the MRI  lumbar CPT codes are mostly lumbar spinal stenosis, lumbar spondylosis, lumbar radiculopathy, lumbar disc displacement and other degenerative disease. MRI are usually to find any tear or sprain present in the soft tissue. Also while coding the diagnosis do use a combination code when two or more diagnosis can be reported with a combination code.
For example, the lumbar radiculopathy (M54.16) has a combination code with lumbar degenerative or disc disease( M51.2 and M51.3 series). The medical coder must use  a combination code from M51.1 series for Lumbar degenerative disease with radiculopathy combination code.
Also do remember do not code 72148 (MRI lumbar without contrast ) with CPT code 72158 because the code 72158 itself includes a with and without contrast exam which include the 72148 exam as well, hence when the medical coder comes across such scenario report only the most comprehensive exam CPT code only.

Do and Don’t with CPT code 72148, 72149 & 72158

Do not code MRI lumbar spine without and with contrast separately when performed on same day on different visit. Combine both report and code 72158 only. This code will represent both the procedure without and with contrast for MRI lumbar spine.

MRI lumbar spine performed after Arthrogram or Myelogram will always be considered as with contrast. If you know about Interventional radiology procedures, you will know that MRI spine exam is performed after diagnostic arthrogram or myelogram. In this procedure they use contrast to inject into the spinal column and immediately after that they perform CT or MRI exam. In such Post-arthrogram or Post-myelogram MRI procedure, we have to use with contrast CPT codes always. For CPT code for MRI Lumbar spine post arthrogram or post myelogram will be 72149.

CPT codes similar to MRI Lumbar Spine

There are many similar and related CPT codes for different region. These procedure codes are related to each other and only differ in the body part. Below are list of MRI cpt codes used in Radiology frequently.

72141  MRI cervical spine; w/o contrast 

72142  MRI cervical spine; with contrast 

72156 MRI cervical spine; w/o contrast followed by contrast

72146 MRI thoracic spine; w/o contrast

72147 MRI thoracic spine; with contrast

72157 MRI thoracic spine w/o contrast followed by cMRI pelvis; with contrastontrast

72195 MRI pelvis; w/o contrast

72196 MRI pelvis; with contrast

72197 MRI pelvis; w/o contrast followed by contrast 

70336 MRI temporomandibular joint(s) 

70540 MRI orbit, face and neck; w/o contrast

70542 MRI orbit, face and neck; with contrast

70543 MRI orbit, face and neck; w/o contrast followed by with contrast

73221 MRI upper extremity, any joint w/o contrast

73222 MRI upper extremity, any joint with contrast 

73223 MRI upper extremity, any joint w/o contrast followed by with contrast

73218 MRI upper extremity, other than joint w/o contrast

73219 MRI upper extremity, other than joint with contrast 

73220 MRI upper extremity, other than joint w/o contrast followed by with contrast

73721  MRI Lower extremity, any joint w/o contrast

73722 MRI Lower extremity, any joint with contrast

73723 MRI Lower extremity, any joint w/o contrast followed by with contrast

73718 MRI Lower extremity, other than joint w/o contrast

73719 MRI Lower extremity, other than joint with contrast

73720 MRI Lower extremity, other than joint w/o contrast followed by with contrast

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