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A: If both an MRI of the brain and an MRI of the pituitary gland are separately requested and performed with a full series of specialized pulse sequences, specifically of the pituitary gland, then an MRI of the brain should be reported two times with a modifier (e.g. –59) appended to the second study. Note that clear, separate and distinct indications for two complete studies must be documented. If just an additional pulse sequence or two, focused on the pituitary gland, are added to the MRI of the brain, the extra sequences would be considered part of the base study, and an MRI of the brain reported only once.
This is similar to the reporting of an MRI of brain and the internal auditory canal. Reference the March/April 2003 feature article of the 黑料网 Radiology Coding Source™ for further discussion.
A: If a high-resolution CT of the chest without contrast that consists of more than just a few extra sections (e.g. supine and prone studies in inspiration and expiration at multiple levels) is performed to better evaluate the parenchyma, report code 71250 (CT thorax, without contrast) and append a –22 modifier (services provided are greater than those usually required). It is recommended that a report be submitted to justify the use of the –22 modifier. It is not appropriate to code for the high resolution separately as all three acquisitions are "unenhanced" chest CT exams.
When a few additional sections are obtained as part of a CT of a particular anatomical region, they are included in the initial examination and not coded separately. However, if two studies are performed at two separate sessions and based on two separate orders, it would be appropriate to report both studies. In this case, one of the studies would require a modifier to indicate separate and distinct studies.