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Magnetic resonance angiography (MRA) is a specialized imaging technique that utilizes magnetic fields and radiofrequency pulses to create detailed images of blood vessels in the head. The procedure identified by CPT® Code 70544 specifically refers to MRA performed without the use of contrast materials. This noninvasive approach allows healthcare professionals to evaluate both arterial and venous structures for various vascular conditions. Common indications for this procedure include the assessment of atherosclerotic stenosis, which is the narrowing of arteries due to plaque buildup, as well as arterial dissection, where the layers of an artery wall separate. Other conditions that may be evaluated include acute thrombosis, which is the formation of a blood clot, aneurysms or pseudo-aneurysms, vascular loops, and vascular malformations or tumors. Additionally, MRA can be useful in identifying arterial causes of pulsatile tinnitus, a condition characterized by hearing a rhythmic sound in the ears. The procedure may also be indicated following vascular surgery on intracranial vessels to monitor their status. During the MRA, multiple images are captured, typically 1-2 mm in thickness, and processed using advanced algorithms to generate maximum intensity projections (MIPs), which provide enhanced visualization of the blood vessels. The resulting images are reviewed by a radiologist, who interprets the findings and provides a written report. This comprehensive imaging technique is essential for diagnosing and managing various vascular conditions in the head without the risks associated with contrast materials.
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Evaluation of Vascular Conditions MRA is performed to assess arterial and venous vessels for conditions such as atherosclerotic stenosis, arterial dissection, acute thrombosis, aneurysms or pseudo-aneurysms, vascular loops, vascular malformations/tumors, or arterial causes of pulsatile tinnitus.
Post-Surgical Assessment MRA may be indicated following vascular surgery on the intracranial vessels to evaluate the vascular status and ensure proper healing and function.
Step 1: Patient Preparation Prior to the MRA, the patient is prepared for the procedure, which includes explaining the process and ensuring that they are comfortable. The patient may be asked to remove any metal objects and change into a gown to prevent interference with the magnetic field.
Step 2: Positioning The patient is positioned on the examination table, which is then moved into the magnetic resonance imaging (MRI) machine. Proper positioning is crucial to obtain clear images of the head and the blood vessels of interest.
Step 3: Image Acquisition The MRA is performed without the use of contrast materials. The MRI machine generates a strong magnetic field and uses radiofrequency pulses to capture multiple images of the head. These images are typically 1-2 mm thick and are taken from various angles to provide a comprehensive view of the vascular structures.
Step 4: Image Processing After the images are acquired, they are processed using an array algorithm to create maximum intensity projections (MIPs). This post-processing step enhances the visualization of the blood vessels, allowing for better identification of any abnormalities.
Step 5: Review and Interpretation The processed MIPs, along with the initial MRA images, are reviewed by a radiologist. The radiologist analyzes the images for any signs of vascular conditions and prepares a written interpretation of the findings, which is then documented in the patient's medical record.
After the MRA is completed, the patient may be monitored briefly to ensure they are stable before being discharged. There are typically no specific post-procedure care requirements since the procedure is noninvasive and does not involve the use of contrast materials. Patients can usually resume their normal activities immediately following the examination. The radiologist's interpretation will be communicated to the referring physician, who will discuss the results with the patient and determine any necessary follow-up actions based on the findings.
| Short Descr | MR ANGIOGRAPHY HEAD W/O DYE | Medium Descr | MRA HEAD W/O CONTRST MATERIAL | Long Descr | Magnetic resonance angiography, head; without contrast material(s) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 4 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic imaging procedures apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 88 - | APC Status Indicator | Codes That May Be Paid Through a Composite APC | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I2C - Advanced imaging - MRI/MRA: brain/head/neck | MUE | 2 | CCS Clinical Classification | 198 - Magnetic resonance imaging |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GC | This service has been performed in part by a resident under the direction of a teaching physician | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GA | Waiver of liability statement issued as required by payer policy, individual case | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | GZ | Item or service expected to be denied as not reasonable and necessary | MF | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | MA | Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AM | Physician, team member service | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | E1 | Upper left, eyelid | ET | Emergency services | GQ | Via asynchronous telecommunications system | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | KX | Requirements specified in the medical policy have been met | MB | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access | MD | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | RT | Right side (used to identify procedures performed on the right side of the body) | SU | Procedure performed in physician's office (to denote use of facility and equipment) | U2 | Medicaid level of care 2, as defined by each state | U6 | Medicaid level of care 6, as defined by each state |
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| 2001-01-01 | Added | First appearance in code book in 2001. |
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