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Magnetic resonance imaging (MRI) is a sophisticated imaging technique utilized to visualize the brain, including the brain stem and skull base, during open intracranial procedures. This procedure is particularly significant as it allows for real-time assessment of the brain's condition while surgery is ongoing. MRI operates on the principle of magnetic properties of hydrogen atoms present in the body, making it a noninvasive and non-radiating method of imaging. During the procedure, the patient is positioned on a motorized table that moves into a large MRI scanner, which contains a powerful magnet. This magnet generates a strong magnetic field that aligns the hydrogen atoms in the body. Subsequently, radiowaves are transmitted through this magnetic field, causing the protons in various tissues to emit specific radiofrequency signals. These signals are captured and processed by a computer, resulting in high-resolution, three-dimensional images of the brain. Intraoperative MRI is performed in specialized surgical suites equipped with MRI scanners, allowing neurosurgeons to obtain critical imaging data at any point during the surgery. This capability is essential for evaluating the extent of tumor removal, assessing residual vascular malformations, or assisting in the placement of deep brain neurostimulator systems. The integration of MRI into surgical procedures enhances the precision of the operation, minimizes the risk of damaging surrounding brain tissue, and ultimately contributes to improved surgical outcomes. The use of contrast material, such as gadolinium, further enhances the visibility of certain structures and abnormalities within the brain, providing the surgeon with vital information to ensure the success of the procedure. When MRI is performed without contrast, a different code is used, and specific coding guidelines apply when contrast is administered during the imaging process.
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The procedure is indicated for various clinical scenarios where real-time imaging of the brain is essential during open intracranial surgery. The following conditions may warrant the use of intraoperative MRI:
The intraoperative MRI procedure involves several critical steps to ensure accurate imaging and effective surgical intervention. The following outlines the procedural steps:
After the intraoperative MRI is completed, the surgical team evaluates the images to confirm the success of the procedure. If any residual tumor or vascular malformation is detected, further surgical intervention may be necessary. The patient is then carefully monitored during the recovery phase, with attention given to any potential complications arising from the surgery or the imaging process. The use of contrast material may require additional monitoring for allergic reactions or other side effects. Overall, the integration of intraoperative MRI into surgical practice enhances the likelihood of successful outcomes and minimizes the risk of postoperative complications.
| Short Descr | MRI BRAIN W/DYE | Medium Descr | MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL | Long Descr | Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with contrast material(s) | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple 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 | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | 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. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2004-01-01 | Added | First appearance in code book in 2004. |
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