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.
