Three answer prior to reporting MR Urogram

Published: 11th June 2010
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ABN

Pre-authorization problem may need ABN.



If your practice carries out MR urograms, you need to be all keyed up to handle a few reimbursement hitches.



You may find conflicting information in researching ways to code MR urograms. For instance, you may come across sources that say to report both abdominal and pelvic MRIs, but you will have to reconcile this advice with certain payers preauthorizing only an abdominal exam.



Safeguard yourself: The MR urogram issue reveals various questions that need to be looked into:



  • First, what did the treating physician order?

  • What did your facility carry out and document?

  • Thirdly, what did the insurance company authorize?

    For both exams, insist on orders



    1. See to it that you have orders from the treating physician for both abdominal and pelvic MRI exams before you think about reporting both - for instance, 74183(Magnetic resonance [e.g., proton] imaging, abdomen; without contrast material[s], followed by with contrast material[s] and further sequences) and 72197 (Magnetic resonance [e.g., proton] imaging, pelvis; without contrast material[s], and further sequences) for exams carried out without and with contrast.



    Auditors will want to take a look at precise orders, so you shouldn't assume that an "MR urography" order refers to abdomen and pelvis. Do not be tempted to think otherwise just because you can easily find support that physicians consider MR urography to cover pelvis and abdomen studies. For example, the American College of Radiology (ACR) "Appropriateness Criteria for Acute Onset Flank Pain" refers to "MRI abdomen and pelvis with or without contrast (MR urography)." (To find out appropriateness criteria, visit www.acr.org. Select the "Quality and Safety Resources" link. Then click on the "ACR Appropriateness Criteria link.) However, for your records, precise orders will offer your claim the most vital support.





    2. Seek distinct documentation: In order to support reporting both abdomen and pelvis MRIs, see to it that the radiologist has documented both exams clearly. Ideally, the radiologist will record each in a separate paragraph, recounting the organs visualized and pertinent comments and findings. For instance, the abdominal MRI documentation might focus on the kidneys and urinary collecting system for anatomical or physiological abnormalities. The pelvic documentation might review any pelvic floor defects associated with urinary incontinence.



    Resource: The ACR provides online practice guidelines for pelvic and abdominal MRIs:



    • Abdomen:

    www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/gastro/mri_abdomen.aspx

    • Pelvis: www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/gastro/mri_pelvis.aspx.



    3. Review need for ABN

    If the insurer preauthorizes only an abdominal MRI, then you can expect the insurer to reimburse only the abdominal MRI. The treating physician may still figure out that both pelvic and abdominal MRI exams are important for the patient. If that's the case, alert the patient that he may be financially responsible for the pelvic MRI. Have him read and sign a waiver or ABN agreeing to cover the cost if he opts for the exam. For Medicare, you should append modifier GA (waiver of liability statement issued as called for by payer policy) to the pelvic MRI code to indicate you have an ABN on file.





    ABN alert: Effective April 1, CMS updated modifiers. Modifier GA changes from "Waiver of liability statement on file," which simply showed that you have a signed ABN on file, Melinda Brown, CMBS, insurance biller with H. Matt Smith, MD, in Kennewick, Wash says.



    The new descriptor is "Waiver of liability statement issued as called for by payer policy." You should go for modifier GA only to report when a required ABN was issued for a service," according to CMS.






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