In medical billing and coding, submitting claims with the correct Current Procedural Terminology (CPT) codes is essential to getting the claims paid without delays. One such relevant code is 73721, which is for MRIs (Magnetic Resonance Imaging) of the lower extremities. The more you know about this code, the more lower extremity MRI claims you will get approved. The purpose of this article is to review this code, and its billing and payment related issues, and propose recommendations for faster payment approval.
What Is the 73721 CPT Code?
The CPT code 73721 describes ‘MRI of the lower extremities without contrast’. This procedure captures detailed images of the lower extremities using magnetic resonance imaging. Specifically the hips, thighs, knees, and legs. This procedure helps evaluate injuries to the joints, arthritis, soft tissue problems and other musculoskeletal disorders.
Key Components of the 73721 Code:
MRI of the Lower Extremity: This diagnostic imaging procedure focuses on the lower body’s bones, muscles, ligaments, and tendons.
Without Contrast: The MRI is performed without the use of contrast agents, which is a notable distinction. Contrast agents are sometimes used in MRIs to highlight certain areas of the body and provide a clearer image, but they are not necessary for all types of diagnostic evaluation.
How Is the 73721 CPT Code Used in Medical Billing?
When MRI procedures are billed out, the proper CPT code must be used for procedures to be reimbursed correctly. The CPT code 73721 should be used for MRIs of lower extremities without the use of contrast. The description of the procedure should be aligned with the clinical indications of the procedure that are provided by the physician.
This is how a medical biller would use the CPT code 73721 correctly:
Documenting correctly
In order for the claim to be accepted, the documentation must mirror the procedure performed. The medical records should detail the lower extremity MRI, including which parts were captured, and state no contrast was used.
Coding correctly
CPT code 73721 should only be used if no contrast was used for the MRI. If contrast was used, the CPT code 73722 should be billed.
Indication for the procedures
The MRI must be ordered for medical reasons. For example, soft tissue injury, arthritis, or any other degenerative conditions which are a part of the musculoskeletal system. This must be done to ensure the claim is correctly aligned with the insurance rules .
Modifiers
In some instances there may be a need for a modifier to describe the specifics surrounding the procedure. For example, if the MRI was done in an atypical location or done in an emergency, a modifier may be necessary to get appropriately reimbursed.
Why Understanding the 73721 CPT Code is Important for Claim Acceptance?
Using the 73721 CPT code correctly helps determine acceptance of your MRI claim. Here are some reasons why understanding this code is important.
Getting Paid Right
Incorrectly using a CPT code can lead to the denial or delay of a claim. This affects cash flow and diverts the billing team to address the problems. Using the right code results in an increased chance of full reimbursement for the service.
Meeting Payer’s Expectations
Medical insurance and governmental payers like Medicare and Medicaid provide reimbursement with claim coding. If the coding is done incorrectly, audits, penalties, or rejection of the claim can occur. Healthcare providers get to understand the specifics of the 73721 code, coding the claims right and meeting the payers’ expectation.
Less Claim Rejections
When coding claims correctly, there are less claims that get rejected. Using the 73721 code means you are filing for an MRI exam with no contrast, which can make the process and your claims less complicated.
Better Operational Efficiency
Your billing team will get to serve claims with great speed, which helps increase overall operational efficiency when they know CPT coding. Revenue is less likely to be lost due to delayed and denied payments with the prompt processing of claims.
Common Mistakes to Avoid When Using the 73721 CPT Code
To improve your MRI claim acceptance rate, it’s crucial to avoid common mistakes when using the 73721 CPT code. Here are a few errors to look out for:
Using the Code Improperly: The most common misuse of 73721 occurs when contrast was actually used. If contrast was administered during the procedure, code 73722 is correct for it. If 73721 is utilized for a study where contrast is indicated, you will get denials.
Failure to Document the Medical Reason for Ordering the MRI: document properly all of the medical reasons why an MRI is medically necessary, insurance companies may later doubt why this test was ordered and deny your claim. Always make sure that the doctor’s notes state why the MRI was ordered.
Failure to Include Necessary Modifiers: There are times where required modifiers such as 26 (Professional Component) or TC (Technical Component) need to appended so that payers can distinguish between the procedures rendered. Just make sure to add the right modifiers where appropriate.
Failure to adhere to payer-specific recommendations: Payers have their own set of codes that are used for MRI. Always double check to make sure that you’re following payer-specific rules for CPT coding so you don’t start seeing more denials.
How to Improve Your MRI Claim Acceptance Rate?
To increase the likelihood of your MRI claims being accepted, consider the following strategies:
1. Maintain Thorough Records
One of the areas to improve in the acceptance of MRI claims is the amount of detail given in the imaging reports. Submit reports that have the details to describe the procedure performed, whether contrast was used, specific locations of the images, and the necessity of the MRI. This provides the payer with the information needed to avoid delays in processing the claim.
2. Apply the Right Modifiers
Modifiers provide additional information about the specific details of a claim. If the MRI was done in a specific setting (e.g. inpatient vs outpatient) or done on an emergency basis, applying the correct modifier will give the insurance company the information needed to justify the level of service.
3. Awareness of Updates in Coding
Every year there are changes to the CPT codes which require health care providers to be aware of the changes. Keep your billing personnel up to date on the changes of the CPT codes that are specific to the MRIs, and whether there are changes to the coding practices for different procedures.
4. Check insurance
Before the MRI is done, checking on the patient’s insurance will help make sure the procedure is covered and whether there are conditions, such as pre-authorization or other documentation.
5. Send Faultless Claims
Claims with fewer claim fallacies have a higher chance of being accepted. Check for missing info, code discrepancies, and the wrong patient details. Sending a claim that is clean and free of errors will reduce the chances of a claim being denied, and help the payment process.
Conclusion
The 73721 CPT code helps with billing for MRIs of the lower extremities without contrast. Knowing how to use this code helps improve billing documentation, coding, and reimbursement processes. Improving the claim acceptance rate for MRIs helps with overall cash flow and billing efficiency. More MRIs can be processed with fewer denials if the organization understands how to use CPT code 73721.
Make An Appintment With A2ZBrief FAQs About 73721 CPT Code
Reimbursement for an MRI lower extremities CPT code 73721 is sought by the physician, requesting payment for personal imaging of the hip, thigh, knee or calf (leg) or if only muscles/tendons/ligamentous/bone tissues Separate reimbursement may be received.
CPT Code 73721 is not the same as CPT Code 73722. 73721 is the code for an MRI w/o contrast and 73722 is for an MRI of lower extremities but with contrast. So for a MRI of lower legs with postcontrast, it would be73722.
The 73721 code is for conditions such as joint injury, arthritis, muscle strain, and soft tissue disorder in the lower body. It is typically employed when no contrast is necessary.
No, the 73721 code is only for MRI of the lower (hips, thighs, knees and legs). Different codes are also utilized for the imaging of the upper extremities.
Sending enough evidence to back up the claim(s) would lessen the odds of a denial. Claiming this CPT code would be easier with the proper explanation of medical necessity, reasons to go for/without contrast MRI and other required modifiers along with appropriate coding, insurance verification and checking out the coverage before submitting for claims.
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