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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 neck. The procedure described by CPT® Code 70549 involves performing MRA without the use of contrast materials initially, followed by the administration of contrast materials to enhance the visibility of the vascular structures. This dual-phase approach allows for a comprehensive evaluation of both the arterial and venous systems, making it particularly useful in diagnosing various vascular conditions. MRA is a noninvasive procedure, meaning it does not require any surgical intervention, and is often employed to assess issues such as atherosclerotic stenosis, arterial dissection, acute thrombosis, aneurysms or pseudo-aneurysms, vascular loops, and vascular malformations or tumors. Additionally, it can help identify arterial causes of pulsatile tinnitus. The initial phase of the MRA captures images without contrast, which can provide baseline information about the vascular anatomy. Following this, contrast material is administered intravenously, allowing for enhanced imaging of the blood vessels. The resulting images are processed using advanced algorithms to create maximum intensity projections (MIPs), which highlight areas of interest for further analysis. The radiologist interprets these images, providing a detailed report of the findings, which is essential for guiding clinical decisions and treatment plans.
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Magnetic resonance angiography (MRA) is indicated for the evaluation of various vascular conditions and abnormalities. The specific indications for performing MRA of the neck include:
The procedure for CPT® Code 70549 involves several key steps to ensure accurate imaging of the neck's vascular structures. The process begins with the patient being positioned comfortably in the MRI machine, which is a large, tube-shaped magnet. The initial phase of the MRA is conducted without the use of contrast materials. During this phase, the MRI machine generates images of the blood vessels using a magnetic field and radiofrequency energy. These images are captured in slices that are typically 1-2 mm thick, providing a detailed view of the vascular anatomy. After the initial imaging is completed, an intravenous line is established to administer contrast material. This contrast agent enhances the visibility of the blood vessels, allowing for a more detailed assessment of any abnormalities. Following the administration of the contrast, additional MRA images are obtained. The images from both phases are processed using advanced algorithms to create maximum intensity projections (MIPs), which highlight areas of interest identified by the radiologist. The MIPs, along with the initial images, are then reviewed by the radiologist, who interprets the findings and prepares a written report detailing the results of the examination.
After the completion of the MRA procedure, patients are typically monitored for a short period to ensure there are no immediate adverse reactions to the contrast material. It is common for patients to resume normal activities shortly after the procedure, as MRA is noninvasive and does not require significant recovery time. The radiologist will review the images and provide a detailed interpretation, which will be communicated to the referring physician. This report is crucial for determining any necessary follow-up actions or treatments based on the findings. Patients may be advised to stay hydrated and report any unusual symptoms following the procedure, particularly if contrast material was used.
| Short Descr | MR ANGIOGRAPH NECK W/O&W/DYE | Medium Descr | MRA NECK W/O &W/CONTRAST MATERIAL | Long Descr | Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences | 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 | 1 | 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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 | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GZ | Item or service expected to be denied as not reasonable and necessary | 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). | 56 | Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number. | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | 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 | 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 | MB | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access | 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 | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | U2 | Medicaid level of care 2, as defined by each state | 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 | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2001-01-01 | Added | First appearance in code book in 2001. |
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