Every year their has been new CPT codes added in Radiology Facility. In 2018, we saw new CPT codes for chest and abdomen X-ray procedures. This was a very big change in radiology facility, because chest and abdomen X-ray procedures are very common and coded frequently by medical coders.This year in 2019, we will seen again some new CPT codes for MRI breast procedures. The old breast MRI codes 77058, 77059 & 0159T are deleted in 2019 and are replaced by four new CPT codes. The new MRI Breast CPT codes are 77046, 77047, 77048 & 77049.

MRI is a non-invasive imaging modality that uses magnetic and radiofrequency fields to image body tissue producing very detailed, cross-sectional pictures of the body. Inconsistent with CT, MRI uses no ionizing radiation and is generally a safe procedure. MRI is sometimes used in combination with mammography. 

Breast magnetic resonance imaging (MRI) for individuals who are high risk for breast cancer as defined as having
any of the following:
o Personal history of breast cancer
o Two or more first degree relatives with breast cancer
o History of radiation therapy to the chest
o Dense breast tissue with any one of the following risk factors:
 Lifetime risk of breast cancer of 20% or greater using standard risk assessment models that are defined
by family history
 Personal history of BRCA1 or BRCA 2 gene mutations
 History of radiation therapy to the chest between the ages of 10-30
 First-degree relative of a BRAC1 or BRACA2 mutation carrier who has not yet been tested
 Personal history or has first degree relative who has Li Fraumeni Syndrome, Cowden syndrome or
Bannayan-Riley-Ruvalcaba syndrome

Read also: When to use Limited Ultrasound abdomen CPT code 76705

Description of CPT codes are 77046, 77047, 77048 & 77049

The new CPT codes will be divided into unilateral and bilateral CPT codes. The use of LT or RT modifier can be used as per coding guidelines for unilateral MRI breast procedures. Also, the codes are with and without contrast, hence it will be important to check the presence or absence of contrast while selecting the correct MRI breast CPT codes in 2019.

• 77046: Magnetic resonance imaging, breast, without contrast material; unilateral
• 77048:  Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral
• 77047: Magnetic resonance imaging, breast, without contrast material; bilateral
• 77049: Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral
• C8937– Computer-aided detection, including computer algorithm analysis of breast mri image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)

Codes 77046 and 77047 are reported for breast MRI without contrast. Codes 77048 and 77049, MRI with computer-aided detection (CAD), can help radiologists identify abnormalities on breast MRI. CAD MRI is used only with contrast-enhanced MRI and would not be performed without contrast. The long-standing Category III code 0159T has been deleted and will no longer be utilized to report breast CAD.

Below MRI breast CPT codes are deleted from 2019, hence medical coders should stop using the below codes for reports On or after 1st january 2019, date of service (DOS).

• 77058 : MRI Breast, Unilateral w/ or w/o contrast
• 77059 : MRI Breast, Bilateral w/ or w/o contrast
• 0159T: Computer aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI (List separately in addition to code for primary procedure)

The CAD will be included with the new CPT code 77048 & 77049 in 2019. Hence, we will no more require code 0159T in 2019 for CAD.

Hospitals will continue to use HCPCS Level II codes C8903–C8908 (note C8904 and C8907 were deleted for 2019) when billing Medicare for breast MRI under the Outpatient Prospective Payment System. The code selection is based on the laterality of the exam and whether contrast is used. When CAD is performed in the hospital outpatient setting, the new HCPCS code C8937 (Computer-aided detection, including computer algorithm analysis of breast MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation [List separately in addition to code for primary procedure]) is assigned and the breast MRI is reported with the appropriate C code.

Computer-aided detection has been used to aid radiologists’ interpretation of contrast-enhanced MRI of the breast, which is sometimes used as an alternative to mammography or other screening and diagnostic tests because of its high sensitivity in detecting breast lesions, even among those in whom mammography is less accurate (e.g., younger women and those with denser breasts)

Read also: When to  use Brain Imaging CPT codes 78600 & 78601

Difference between Oral and Intravenous contrast

While coding with and without contrast for MRI breast exam, coders should understand the difference between oral and intravenous contrast. Still medical coders have confusion about coding oral contrast.

Oral contrast is never considered as with contrast exam. Only IV (intravenous contrast) is considered as with contrast. Hence, while coding MRI breast CPT codes do remember the use of contrast (oral or intravenous).