Practice Management

Good afternoon,

Our practice is seeking information on how to properly bill for whole body executive MRI screenings.

Ideally, we would like for our minimum charge to be a combination of at least the following three studies:

• Head CT w/o
• Neck CT w/o
• Chest, abdomen and pelvis CT w/o

Does anyone know whether or not there are codes for this?  If not, how do you bill for such studies?

Thanks in advance for your responses.  


------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------

Original Message:
Sent: 3/11/2021 4:13:00 PM
From: Ashley Browning
Subject: Executive MRI Screening

Good afternoon,

Our practice is seeking information on how to properly bill for whole body executive MRI screenings.

Ideally, we would like for our minimum charge to be a combination of at least the following three studies:

• Head CT w/o
• Neck CT w/o
• Chest, abdomen and pelvis CT w/o

Does anyone know whether or not there are codes for this?  If not, how do you bill for such studies?

Thanks in advance for your responses.  


------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------

Hello Renee -

Thank you!  Your response is very helpful.

Kind regards,

------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------

Original Message:
Sent: 03-11-2021 23:03
From: Renée Engle
Subject: Executive MRI Screening

Ashley,

 

There is no established CPT code for a whole-body MRI or CT, there are a couple of coding options

• Unlisted code

CT - 76497 – Unlisted computed tomography procedure (eg, diagnostic, interventional)

MRI - 76498 - Unlisted magnetic resonance procedure (eg, diagnostic, interventional)

 

Challenges

a. No RVU

b. Fee should align with typical charge for each service, perhaps at a reduced rate

c. However, payor will determine payment, solely based on documentation

d.  Some payors, but not all, are paying for the unlisted codes

e. Payors typically will not authorize an unlisted CPT code

f. Claim must go to medical review, could take up to 120 days for adjudication

g. Since this is generally a screening exam, having the patient pay upfront may be an option or negotiate with the employers if they are requiring the executives to have the screening exams.

 

• Bill MRI or CT for each body part

As an option, this will depend on how the study is ordered, performed, and documented. Generally, in this case each individual body part is a limited exam, therefore a -52 (reduced) modifier would be applied.

Feel free to contact me if you would like to discuss further.

 

Sincerely,

Renée C. Engle, RCC, RCCIR, FRBMA

Senior Vice President, Client Services

MSN Healthcare Solutions

 

rengle@msnllc.com

678-342-2578 (O)  | 770-815-4650 (M) | 678-342-5359 (F)
MSNLLC.com

 

Original Message:
Sent: 3/11/2021 4:13:00 PM
From: Ashley Browning
Subject: Executive MRI Screening

Good afternoon,

Our practice is seeking information on how to properly bill for whole body executive MRI screenings.

Ideally, we would like for our minimum charge to be a combination of at least the following three studies:

• Head CT w/o
• Neck CT w/o
• Chest, abdomen and pelvis CT w/o

Does anyone know whether or not there are codes for this?  If not, how do you bill for such studies?

Thanks in advance for your responses.


------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------

Hello Ashley,
Renee was spot on with regards to billing codes. That said, many years ago, at a former practice, we provided executive screening exams. The experience suggests that you consider the following. Most if not all insurance companies will require pre-authorization for an MRI or CT. Chances are that you will receive denials based on lack of clinical indication. I would suggest that you negotiate discounted fees directly with the employer who is interested in paying for their executives. Additionally, I would suggest that you consider preforming an internet search on executive screening services elsewhere for templates. The final caution is in finding false positives when performing this type of work. Your radiologists will have no clinical history for which to focus their evaluation. A great way to consider starting a screening program is to provide lung cancer screening. There is a wealth of information and precedence. Good Luck with this project!

------------------------------
Steve Schreiber FRBMA
Director of Marketing General Manager Radiology Business
HealthLevel
Mountain View CA
------------------------------

Original Message:
Sent: 03-11-2021 16:12
From: Ashley Browning
Subject: Executive MRI Screening

Good afternoon,

Our practice is seeking information on how to properly bill for whole body executive MRI screenings.

Ideally, we would like for our minimum charge to be a combination of at least the following three studies:

• Head CT w/o
• Neck CT w/o
• Chest, abdomen and pelvis CT w/o

Does anyone know whether or not there are codes for this?  If not, how do you bill for such studies?

Thanks in advance for your responses.


------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------

Thank you, Steve.

Your information is very helpful!


------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------

Original Message:
Sent: 03-17-2021 14:18
From: Steve Schreiber
Subject: Executive MRI Screening

Hello Ashley,
Renee was spot on with regards to billing codes. That said, many years ago, at a former practice, we provided executive screening exams. The experience suggests that you consider the following. Most if not all insurance companies will require pre-authorization for an MRI or CT. Chances are that you will receive denials based on lack of clinical indication. I would suggest that you negotiate discounted fees directly with the employer who is interested in paying for their executives. Additionally, I would suggest that you consider preforming an internet search on executive screening services elsewhere for templates. The final caution is in finding false positives when performing this type of work. Your radiologists will have no clinical history for which to focus their evaluation. A great way to consider starting a screening program is to provide lung cancer screening. There is a wealth of information and precedence. Good Luck with this project!

------------------------------
Steve Schreiber FRBMA
Director of Marketing General Manager Radiology Business
HealthLevel
Mountain View CA

Original Message:
Sent: 03-11-2021 16:12
From: Ashley Browning
Subject: Executive MRI Screening

Good afternoon,

Our practice is seeking information on how to properly bill for whole body executive MRI screenings.

Ideally, we would like for our minimum charge to be a combination of at least the following three studies:

• Head CT w/o
• Neck CT w/o
• Chest, abdomen and pelvis CT w/o

Does anyone know whether or not there are codes for this?  If not, how do you bill for such studies?

Thanks in advance for your responses.


------------------------------
Ashley Browning BSISM, RT(R)(M)| Quality Improvement Specialist
Radiology Associates, P.A. | 500 S. University Ave, Suite 600 | Little Rock, AR 72205
abrowning@rapaxray.com | phone 501.686.2640
------------------------------