Neurology coding assigns CPT codes to tests and procedures for the brain, spinal cord, and nervous system. Proper coding ensures correct reimbursement and reduces claim denials. Many healthcare facilities choose to outsource medical billing services to ensure accuracy and efficiency in this complex process.

One important neurology code is CPT Code 70551. In this article, we will cover all the essential details you need to know about this code.

70551 CPT Code Description

CPT Code 70551 is used for an MRI of the brain without contrast dye. This code applies when a doctor needs to examine the brain or nervous system in detail, such as in cases of stroke, brain tumors, multiple sclerosis, or chronic headaches. For instance, if a patient has frequent headaches and the doctor suspects a brain abnormality, an MRI without contrast is performed and billed using CPT Code 70551. Accurate use of this code ensures proper diagnosis and helps secure correct reimbursement.

When to Use CPT Code 70551

Here are the major uses of CPT Code 70551 in neurology treatment:

1. Assessment of Brain Structures and Blood Vessels (Non-contrast)

Non-contrast MRI provides detailed images of brain tissue, helping doctors evaluate structural abnormalities. While it shows some larger blood vessels, detailed evaluation for aneurysms or AVMs requires an MRA (Magnetic Resonance Angiography), which is coded separately, for example CPT 70544 (without contrast) or 70545 (with contrast).

2. Evaluation of Traumatic Brain Injury (TBI)

After a head injury, non-contrast MRI can show damage to soft brain tissue. It can detect problems like diffuse axonal injury, though very small changes might not be seen. CPT code 70551 is used for this type of MRI.

3. Detection of Congenital Brain or Brainstem Abnormalities

CPT code 70551 is used to check for brain and brain stem defects present from birth. The MRI gives clear images that help doctors plan treatment.

4. Infection or Inflammation

Non-contrast MRI can detect brain infections or inflammation, like meningitis or encephalitis. These conditions change the brain tissue in ways the scan can show. CPT code 70551 applies for this MRI.

5. Evaluation of Brain Ventricles and Cerebrospinal Fluid

CPT Code 70551 includes evaluation of brain ventricles and cerebrospinal fluid. This standard non-contrast MRI can help identify issues such as hydrocephalus or blockages, supporting diagnosis and treatment planning.

Supported Modifiers for Billing 70551 CPT Code

CPT Code 70551 is used for Magnetic Resonance Imaging (MRI) of the brain, including the brainstem, without the use of contrast material. This procedure helps evaluate neurological conditions such as stroke, tumor, or demyelinating diseases. When billing this service, appropriate modifiers must be applied based on the scope of work performed, whether it involves the professional interpretation, the technical process, or specific clinical circumstances. These modifiers apply when working with CPT Code 70551:

Modifier 26

Use modifier 26 with CPT Code 70551 when billing only for the professional component of the MRI, meaning the radiologist provides interpretation and a detailed report but does not supply the MRI equipment or staff. This modifier separates the professional fee from the technical portion, ensuring accurate reimbursement when different entities perform these services.

Modifier TC

Apply modifier TC with CPT Code 70551 when billing for only the technical component of the MRI, which includes the use of the MRI scanner, technologist supervision, and all supplies involved in image acquisition. This modifier is typically used by imaging centers or hospitals that provide the scanning service but do not interpret the results.

Modifier 59

Use modifier 59 when the MRI procedure (CPT 70551) is distinct or independent from other services performed on the same day. For example, if a brain MRI and a cervical spine MRI are both performed during the same encounter for different clinical reasons, modifier 59 clarifies that the procedures are separate and should not be bundled under National Correct Coding Initiative (NCCI) edits.

Modifier 76

Append modifier 76 to CPT 70551 when the same physician repeats the MRI on the same day, usually due to factors such as patient movement, technical failure, or the need for additional imaging sequences. This modifier indicates a repeat service by the same provider and must be supported by documentation explaining the reason for repetition.

Modifier 77

Use modifier 77 with CPT Code 70551 if the MRI is repeated on the same day by a different physician. This modifier helps distinguish the second interpretation or procedure performed by another radiologist or specialist, ensuring the payer understands it was not a duplicate billing.

Modifier 52

Apply modifier 52 when the MRI service is intentionally reduced or limited in scope. This occurs when only a portion of the standard MRI sequences is completed—often due to patient intolerance, emergency interruptions, or specific clinical instructions. Documentation must clearly indicate why the procedure was partially performed.

Modifier 53

Use modifier 53 when the MRI is started but discontinued before completion for valid medical reasons. Common scenarios include patient distress, claustrophobia, or equipment malfunction. This modifier informs payers that the service was partially performed and helps secure partial reimbursement when supported by appropriate clinical documentation.

Modifier 22

Append modifier 22 when the MRI requires significantly more time, effort, or technical difficulty than usual. This may occur in cases involving pediatric patients, severe motion artifacts, or complex positioning. Supporting notes must explain the additional work performed, as some payers require detailed justification for increased procedural effort.

How to Document CPT Code 70551 in Medical Records

When documenting CPT 70551 in medical records, you need to be clear and simple. CPT 70551 is a brain MRI without contrast. In the patient’s chart, write why the MRI is needed, like headaches, stroke check, or nerve problems. Include the date of the MRI, type of scan, and what the results showed. 

Also, note if anything special happened during the scan or if the patient had any problems. Writing everything clearly helps insurance pay for the scan and makes it easy for other doctors to understand the patient’s care.

Medicare Reimbursement for CPT Code 70551

CPT Code 70551 is covered by Medicare under the Medicare Physician Fee Schedule (MPFS), though exact payment may vary by region depending on the Medicare Administrative Contractor (MAC) and any local coverage determinations (LCDs).

Each MAC may issue its own local coverage determinations (LCDs), which outline specific rules, documentation requirements, and conditions for coverage. These rules can influence how much Medicare will reimburse for CPT 70551.

Because of these variations, healthcare providers should always check with their regional MAC to understand the latest reimbursement rates, required documentation, and any special policies that apply to this code. Staying up-to-date helps ensure accurate billing and reduces the risk of claim denials.

Conclusion

Accurate use of CPT Code 70551, along with appropriate modifiers, ensures proper documentation, Medicare reimbursement, and minimized claim denials. 

For healthcare providers, understanding when and how to apply CPT 70551 is essential for patient care and smooth billing processes. Implementing best practices in documenting indications, scan details, and outcomes helps streamline neurology billing services. Overall, mastery of CPT Code 70551 supports both clinical decision-making and financial accuracy, making it an indispensable part of modern neurology practice.

Gastroenterology billing involves managing medical codes, claims, and payments for procedures related to the digestive system. It ensures that gastroenterologists receive accurate reimbursement for services such as colonoscopies, endoscopies, and other digestive health treatments. 

Because these procedures require precise documentation, many practices rely on specialized medical billing services to handle coding and claim submission efficiently.Suppose, if a patient visits a gastroenterologist with stomach pain and a colonoscopy reveals a small polyp that is removed using the snare technique, the correct code to bill is CPT 45385.

This guide explains the CPT 45385 procedure code in detail, covering billing guidelines, documentation tips, and common errors so you can submit clean, accurate gastroenterology claims every time.

45385 CPT Code Description

CPT Code 45385 is used when a routine colonoscopy turns into a therapeutic procedure. If the physician finds a polyp or abnormal growth during the exam and removes it immediately, the procedure changes from a screening to a treatment session.

The primary goal of this procedure is to identify and remove polyps before they can become cancerous. The doctor performs this using a snare technique, a looped wire that tightens around the base of the polyp and removes it. 

There are two types of snare methods, the cold snare, used for very small polyps under 5 mm, and the hot snare, used for larger polyps. CPT code 45385 covers both techniques.

When to Use CPT Code 45385

CPT code 45385 is often applied in colonoscopy procedures when polyps are removed. Here are three common situations to illustrate its use:

1. Hot Snare Removal of an Adenomatous Polyp

Adenomatous polyps, or adenomas, are the most frequently encountered colon polyps. While most are harmless, they can develop into colorectal cancer if left untreated. Suppose if a 55 year old man undergoes a routine screening colonoscopy due to a family history of colorectal cancer. A 6 mm adenomatous polyp is removed with a hot snare, and CPT code 45385 is used for billing.

2. Cold Snare Removal of Multiple Serrated Polyps

Serrated polyps appear in roughly 30% of colonoscopies. Though only a minority progress to cancer, their faster growth makes early removal important. Let’s take an example if a 45 year old woman visits her doctor for unexplained diarrhea. During a colonoscopy, the physician removes two small serrated polyps (3 mm and 4 mm) using a cold snare, reporting the procedure with CPT code 45385.

3. Removal of Recurrent Polyps in Follow-Up Colonoscopy

Polyps can reappear after initial removal, with 25-30% of patients having new polyps in follow-up exams. Timing depends on previous polyp size and type. Suppose a 61 year old woman returns three years after large polyps were removed. A new 6 mm adenoma is excised with a hot snare during her follow-up colonoscopy, and CPT code 45385 is billed.

4. Removal of Sessile Polyps During a Diagnostic Colonoscopy

Sessile polyps are flat or slightly raised growths in the colon. They are more difficult to detect and remove than pedunculated polyps. However, they can still become cancerous if left untreated. Suppose a 58 year old man complains of mild abdominal discomfort. During a diagnostic colonoscopy, the gastroenterologist identifies a 7 mm sessile polyp in the ascending colon and removes it using a hot snare. The procedure is billed with CPT code 45385.

Supported Modifiers for Billing 45385 CPT Code

Modifiers help clarify the circumstances under which CPT Code 45385 (colonoscopy with polypectomy) was performed. Using the correct modifier ensures accurate colonoscopy billing, prevents claim denials, and supports proper reimbursement. Here are the most commonly used modifiers for this code:

1. Modifier PT

Indicates that the colonoscopy began as a screening but became therapeutic or diagnostic after a polyp was found and removed.

2. Modifier 22

Used when the colonoscopy is unusually difficult or complex, requiring significantly more time or effort than usual.

3. Modifier 53

Applies when the procedure is started but must be stopped for medical or safety reasons before completion.

4. Modifier 59

Reports that another procedure was performed during the same session that is separate and distinct from the primary service.

5. Modifier 52 

Used when only part of the procedure is performed, but not the entire service as described by CPT Code 45385.

Correctly applying these modifiers is essential for compliance and accurate reimbursement in colonoscopy billing.

How to Bill and Get Reimbursed for CPT Code 45385

Incorrect coding of CPT Code 45385 for polyp removal is a common cause of claim denials, resulting in lost time and revenue. To ensure accuracy and maximize reimbursement, follow these expert tips for billing CPT 45385 correctly.

Verify Payer Specific Rules for CPT Code 45385

While the Affordable Care Act generally covers colorectal cancer screening, payer policies can vary. Some insurers may apply co-payments or coinsurance if a screening becomes a therapeutic procedure.

Always confirm that CPT Code 45385 is covered with no patient cost-sharing under the plan. Performing an eligibility check before billing speeds up reimbursement and enhances patient satisfaction.

Use CPT Code 45385 Precisely

CPT 45385 applies when a colonoscopy involves the removal of polyps, tumors, or other lesions using a snare technique, with or without electrocautery.

Do not confuse this code with other polypectomy codes such as 45380 (cold biopsy) or 45384 (hot biopsy). Double-check all code descriptions before claim submission to ensure accuracy.

Document Thoroughly for CPT Code 45385

Incomplete documentation is a leading reason for denied claims. Each operative note should clearly state whether the colonoscopy was performed for screening, diagnosis, or follow-up. Include details such as:

• Number, size, and location of all polyps removed
• Removal technique used (e.g., snare, electrocautery)
• ICD-10 diagnosis codes showing medical necessity
• Any specimens sent for pathology and their findings

Complete, accurate documentation not only supports proper reimbursement but also protects the provider during audits.

Sequencing Modifiers with CPT Code 45385

If you need to use more than one modifier, the order is important. Always put the modifier that affects payment first, and then add the modifier that only gives extra information.

Conclusion

The CPT Code 45385 stands out in the field of gastroenterology to ensure proper and accurate billing for colonoscopy procedures involving polyp removal. From hot to cold snare techniques, coding and documentation have a direct bearing on reimbursement and compliance.

To reduce claim denials by up to 20% and speed up reimbursement, follow payer-specific rules, use the appropriate modifiers (such as PT, 22, or 59), and maintain detailed operative notes.

Collaborating with gastroenterology billing service providers streamlines the process and reduces errors. This helps maximize reimbursement and allows physicians to focus more on patient care.

CPT Code 72148 is essential for accurate radiology billing, especially for MRI scans of the lower back (lumbar spine). Using this code correctly ensures that healthcare providers are properly reimbursed for these services.

Mistakes in coding can lead to denied claims and delayed payments. This guide will walk you through the key details for using CPT Code 72148 correctly and help you avoid common billing errors.

72148 CPT Code Description

CPT Code 72148 is used for a lumbar MRI (Magnetic Resonance Imaging) of the lower back without contrast. This scan uses powerful magnets and radio waves to produce detailed images of the vertebrae, discs, spinal cord, and surrounding soft tissues.

Doctors use this MRI to diagnose conditions such as herniated discs, spinal stenosis, degenerative disc disease, tumors, infections, and nerve problems. The procedure is non-invasive, does not involve radiation, and usually takes 30 to 45 minutes.

Key Uses of CPT Code 72148 in Spinal Imaging

Here are the key uses of CPT code 72148:

Imaging of the Lumbar Spine

CPT Code 72148 is used for MRI imaging of the lumbar spine, including the vertebrae, discs, spinal cord, and surrounding soft tissues. This detailed scan helps diagnose conditions such as herniated discs, spinal stenosis, and nerve root compression.

The MRI provides clear images of the bones, intervertebral discs, spinal cord, nerve roots, ligaments, and muscles around the spine, allowing healthcare providers to accurately assess and treat lumbar spine conditions.

Without Contrast Material

CPT 72148 applies specifically to MRI scans performed without contrast agents like gadolinium. This type of MRI uses only magnets and radio waves to produce detailed images, making it safe for patients who cannot receive contrast.

It is commonly used when contrast isn’t medically necessary or when patients have contraindications, such as severe kidney disease or allergies to contrast agents. Proper use of CPT 72148 ensures accurate radiology billing and reduces the risk of claim denials.

Diagnostic Purpose

An MRI billed under CPT Code 72148 is used to diagnose and evaluate various lumbar spine problems, including herniated discs, spinal stenosis (narrowing of the spine), degenerative disc disease, facet joint arthritis, and nerve root compression.

This lower back MRI provides detailed images that help doctors pinpoint the exact cause of symptoms such as back pain or nerve issues. Accurate imaging under CPT 72148 allows healthcare providers to plan the most effective treatment and ensure proper documentation for radiology billing.

Non-Contrast Imaging Specificity

Since this MRI doesn’t use contrast, it focuses on structural changes in the spine rather than highlighting areas like inflammation, tumors, or blood flow, which typically require contrast. This makes it especially good for spotting mechanical issues like disc bulges, degenerative changes, or bone abnormalities.

Common Errors to Avoid When Using 72148 CPT Code

CPT Code 72148 is used for billing an MRI of the lumbar spine without contrast. While this code is essential for accurate billing, medical billers and coders often make errors that can result in claim denials. Below are some common mistakes related to this code and tips on how to avoid them:

Incorrect Code Selection

A common error is using incorrect codes for cervical or thoracic MRIs instead of 72148, leading to claim rejections. It is vital to confirm that the MRI is for the lumbar spine, not other regions, to ensure the correct code is applied.

Missing or Insufficient Documentation

For CPT Code 72148 to be processed correctly, documentation must clearly show the medical necessity of the MRI and include detailed information about the procedure. Insurance payers often deny claims when physician notes don’t explain why the MRI of the lumbar spine was required.

To avoid rejections, ensure that the patient’s medical record fully supports the use of CPT Code 72148, including the reason for the MRI, clinical findings, and specific details of the examination. Proper documentation not only prevents claim denials but also supports accurate radiology billing and faster reimbursements.

Bundling Errors

Bundling errors are a common issue when billing CPT Code 72148 for lumbar MRI procedures. Some billers mistakenly combine the MRI with other services unless the payer’s specific guidelines allow it. These errors happen when multiple procedures are grouped under one code without proper justification, often leading to claim denials or payment delays. Always verify payer rules to ensure that the lumbar MRI is billed separately and correctly within radiology billing guidelines.

Failing to Differentiate Between With and Without Contrast

CPT Code 72148 is exclusively for MRIs performed without contrast. If contrast was used, apply the correct alternative:

CPT Code 72149: MRI lumbar spine with contrast material

CPT Code 72158: MRI lumbar spine without contrast, followed by with contrast and further sequences

Using the wrong code based on contrast usage will result in automatic claim rejection.

Modifiers to Use with CPT Code 72148

When billing for an MRI of the lumbar spine without contrast using CPT Code 72148, there are certain modifiers that may be needed based on the situation. Modifiers provide extra details about the procedure and help prevent claim denials. Here is a list of modifiers that could apply:

Modifier 26

Modifier 26 is used when billing for the physician’s interpretation of the MRI, typically by a radiologist who does not own the equipment.

Modifier TC

This modifies use when radiology billing only for the facility’s services, including equipment use, technician time, and the actual scanning procedure. Hospitals and imaging centers typically use this modifier.

Modifier 52

This modifies use of this modifier if the MRI procedure was partially reduced or if it was not performed in the usual way. This could happen if there were limitations during the procedure or if fewer images were taken.

Modifier 53

This modifier is used if the MRI was started but then stopped, typically due to unforeseen circumstances or medical reasons, like the patient’s condition or issues with the equipment.

Modifier 59

If the MRI is performed alongside other procedures on the same day but should be treated as a separate and distinct service, this modifier is used. It ensures the MRI isn’t mistakenly bundled with other services.

Modifier 76

If the same physician repeats the MRI on the same day due to clinical necessity, this modifier is used to indicate that the procedure was repeated by the same doctor.

Modifier 77

If a different physician repeats the MRI on the same day, use this modifier. This usually happens if another doctor needs to confirm the findings or conduct a more detailed exam.

Billing and Reimbursement Guidelines for CPT Code 72148

If your claim for CPT code 72148 was denied due to medical necessity or another reason, here’s a guide to help you bill it correctly and ensure reimbursement:

Coverage and Documentation Requirements

Medicare coverage for CPT code 72148 is conditional and applies only when specific criteria are met. The procedure must be medically necessary, and your clinical documentation must provide clear evidence of why the MRI is needed. This includes:

• A detailed account of the patient’s medical history.
• Document the physical examination results that justify the MRI.
• Include information on any treatments the patient has already tried.

Some insurers require patients to undergo at least four weeks of conservative treatment before approving an MRI for non-emergency conditions. Make sure to include this treatment history to avoid claim denials.

Reimbursement Rates

The reimbursement rate for CPT Code 72148 can vary depending on your location and the type of facility where the MRI is performed. Since rates differ between hospital and non-hospital settings, it’s best to check with your local Medicare Administrative Contractor (MAC) for the most accurate information. You can also use the Medicare Physician Fee Schedule (PFS) Lookup Tool to find the exact CPT 72148 reimbursement rate for your area.

Pre-Authorization Requirements

Many insurance providers require prior authorization for CPT code 72148 before performing the MRI. This process involves submitting detailed clinical information, such as:

• Symptoms and how long they’ve been present.
• Any treatments attempted before the MRI.
• Physical exam findings.
• The clinical questions the MRI will answer.

Without prior authorization, your claim may be denied, so it’s crucial to verify with the insurance payer if it’s needed. Be sure to obtain approval before performing the MRI. Also, check if there are additional billing requirements to ensure your claim is processed smoothly.

Audit Checklist for CPT Code 72148 Claims

Conducting a proper audit for CPT Code 72148 claims ensures accuracy, compliance, and timely reimbursement in radiology billing. Use the following checklist to review MRI lumbar spine claims and avoid denials:

1. Verify CPT Code Accuracy

Confirm that CPT Code 72148 is the correct code for the MRI of the lumbar spine (without contrast).

2. Confirm Patient Eligibility

Verify that the patient’s insurance covers MRI procedures and that all demographics and policy details are accurate.

3. Medical Necessity Documentation

Include the physician’s MRI order and clear justification for the procedure based on symptoms, diagnosis, or prior findings.

4. Review Clinical Notes

Ensure relevant clinical notes and patient history support the need for the MRI procedure.

5. Check Modifier Use

Apply appropriate modifiers such as 26 (professional component) or TC (technical component), if required.

6. Verify Insurance Pre-Authorization

Confirm that pre-authorization was obtained when required by the payer to prevent claim denials.

7. Ensure Correct Diagnosis Codes (ICD-10)

Use ICD-10 codes that accurately support the medical necessity of the MRI procedure.

8. Review the Radiology Report

Make sure the MRI report clearly describes the findings and is signed by the interpreting physician.

9. Check Billing Details

Confirm the place of service, provider details, and all required billing information before claim submission.

10. File Claims on Time

Submit claims within the payer’s timely filing limits to ensure prompt reimbursement.

11. Follow Up on Claim Status

Track each claim after submission to identify delays, denials, or requests for additional information.

A thorough audit of CPT Code 72148 claims helps maintain compliance, reduce denials, and strengthen overall radiology billing accuracy.

Bottom Line

Accurate code selection, proper documentation, and adherence to payer guidelines are crucial to avoid claim denials. Common errors include using incorrect codes, insufficient documentation, and failing to distinguish between MRIs with and without contrast, such as CPT Code 72148 for a non-contrast MRI of the lumbar spine.

By following the correct billing guidelines and using the right modifiers, you can speed up claim processing and enhance accuracy. For healthcare providers seeking assistance with radiology billing services, Nexus io offers expert support to ensure accurate claims and smooth reimbursements for MRI procedures and more.