New Cardiac MRI codes take Effect January 1, 2008
The updated Current Procedural Terminology (CPT) Category I codes released by the
American Medical Association will go into effect on Jan. 1st, 2008. There will be eight
new cardiac MRI codes (75557-75564) and they will completely replace the 5 existing
codes (75552-75556). The new codes were established to more accurately describe
cardiac magnetic resonance imaging services as they are currently performed.
The reason for the change is that cardiac magnetic resonance (CMR) technology has
significantly changed since the original CPT codes were established in 1993. At that
time, the technology limited the procedure to relatively few indications. Improvement in
spatial and temporal resolution has expanded the applications of CMR from
predominantly an anatomic test to one that performs accurate physiologic evaluations.
During a typical CMR examination anatomic static images are coupled with moving
functional images to provide a unique analysis of morphology and cardiac function.
Additionally, a clinician can apply flow and velocity sequences to patients with valvular
or congenital heart disease for an accurate physiologic assessment. Finally, CMR can also
be used as a technique to assess ischemic heart disease. For example, contrast techniques
can be employed to evaluate myocardial viability, prior to revascularization.
Improvements in CMR hardware and software now allow versatility in the assessment of
myocardial ischemia depending on the clinician’s expertise. Pharmacological stress
testing to identify myocardial ischemic risk can be done using either wall motion
techniques (similar to stress echocardiography) or perfusion techniques (similar to
radionuclide techniques).
New Cardiac MRI CPT Codes
75557 Cardiac magnetic resonance imaging for morphology and function without contrast material;
75558
with flow/velocity quantification
75559
with stress imaging
75560
with flow/velocity quantification and stress
75561 Cardiac magnetic resonance imaging for morphology and function without contrast
material(s) followed by contrast material(s) and further sequences;
75562
with flow/velocity quantification
75563
with stress imaging
75564
with flow/velocity quantification and stress
Each of the above codes was designed to be a stand-alone code and, as such, no add-on
codes will exist. The new codes also cannot be billed together. Additionally, image post
processing is included in each of the new codes so one can no longer bill any of the new
codes with CPT code 76376 or 76377. Note that the new codes are divided into noncontrast and contrast sections each including four codes that build on the first or base
code, of the given section.
Some clinical examples for each code along with a description of work for each are given
below in order to provide guidance for the use of the new codes. The clinical examples
provided are representative but by no means comprehensive.
Non-Contrast Codes
Code 75557 Cardiac magnetic resonance imaging for morphology and function without
contrast material
This code would represent the base code for work in cardiac magnetic resonance where
contrast would not be necessary. The code would be applied in the evaluation of left
and/or right ventricular function and cardiac morphology when necessary. Clinical
applications would include the assessment of discrepant left ventricular functions
between two prior cardiovascular tests, evaluation of left ventricular ejection fraction
prior to implantable cardioverter defibrillator, and serial follow-up of patients with
cardiomyopathies.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Compare to all pertinent available prior studies
Dictate report for medical record
Review and sign report
Discuss findings with referring physician
Code 75558 Cardiac magnetic resonance imaging for morphology and function without contrast
material; with flow/velocity quantification
This code builds from the base code and adds flow and velocity quantification to a morphology and
functional assessment of the heart. This code could be used clinically in the initial evaluation and
serial follow-up of patients with valvular or congenital heart disease.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Use velocity imaging protocols with post-processing to quantify valve function
Compare to all pertinent available prior studies
Review and sign report
Discuss findings with referring physician
Code 75559 Cardiac magnetic resonance imaging for morphology and function without
contrast material; with stress imaging
This code adds non-contrast stress imaging to the base code of function and morphology.
Therefore this code would be utilized for stress assessment that does not rely on contrast
such as a dobutamine MRI, where wall motion is evaluated. Because the work
description includes the base code a function and morphology assessment must be done
along with the stress evaluation.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Evaluate multiple cardiac segments at incremental levels of stress for abnormal wall motion
Compare to all pertinent available prior studies
Review and sign report
Discuss findings with referring physician
Code 75560 Cardiac magnetic resonance imaging for morphology and function without
contrast material; with flow/velocity quantification and stress
This code would be the most labor intensive code within the non-contrast section because
it includes all three separate aspects of analysis – morphology/function, velocity/flow
quantification, and stress imaging. This code might be utilized in a patient who needs an
assessment of valvular heart disease in addition to an ischemic evaluation utilizing
dobutamine.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Evaluate multiple cardiac segments at incremental levels of stress for abnormal wall motion
Compare to all pertinent available prior studies
Review and sign report
Discuss findings with referring physician
Contrast Codes
Code 75561 Cardiac magnetic resonance imaging for morphology and function without contrast
material(s) followed by contrast material(s) and further sequences;
This code represents the base code for the contrast section. The use of this code clinically could
apply to the patient with coronary artery disease who is being assessed for viable myocardium prior
to revascularization.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret source and reformatted images resulting from the study, typically including cine review
with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Interpret pre and post-contrast images to assess myocardial viability
Compare to all pertinent available prior studies
Dictate report for medical record
Review and sign report
Discuss findings with referring physician
Code 75562 Cardiac magnetic resonance imaging for morphology and function without contrast
material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification
Flow and velocity quantification is added to the contrast base code and this code includes the work
of both assessments. Clinical utilization examples of this code would include assessment of a patient
with congenital heart disease or cardiomyopathy with concomitant valvular heart disease.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Use velocity imaging protocols with post-processing to quantify valve function
Interpret pre and post-contrast images to assess myocardial viability and infiltrative disease
Compare to all pertinent available prior studies
Dictate report for medical record
Review and sign report
Discuss findings with referring physician
Code 75563 Cardiac magnetic resonance imaging for morphology and function without contrast
material(s), followed by contrast material(s) and further sequences; with stress imaging
In addition to the contrast function and morphology work, this code adds contrast stress analysis
which would be perfusion imaging. Viability analysis could also be done within this code. Clinically
this code could be applied in a patient with known coronary artery disease with prior coronary artery
bypass graft placement who is being referred for an ischemic evaluation prior to potential invasive
evaluation.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Evaluate multiple cardiac segments at incremental levels of stress for abnormal wall motion and
viability
Interpret pre and post-contrast images to assess myocardial ischemia and viability
Compare to all pertinent available prior studies
Dictate report for medical record
Review and sign report
Discuss findings with referring physician
Code 75564 Cardiac magnetic resonance imaging for morphology and function without contrast
material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification
and stress
This would be the highest level of physician work not only for the contrast section but for all cardiac
MR codes. This code encompasses the work of function and morphology, velocity/flow
quantification, and contrast stress imaging. This code could be applied in a highly complex patient
who needs assessment of valvular heart disease and ischemic heart disease utilizing perfusion stress
imaging.
Representative Description of Work
Review medical chart and records
Review any prior imaging studies
Review protocol with technologist
Describe procedure to patient and obtain consent as needed
Review source imaging data
Supervise administration of anxiolytic where applicable
Supervise set-up for different anatomical imaging planes
Review study images and provide input on whether to obtain additional imaging planes or
sequences
Supervise and/or create reconstructions of the heart and mediastinum using an independent
workstation
Adjust the projection of the reconstructions to optimize visualization of anatomy or pathology
Interpret the source and reformatted images resulting from the study, typically including cine
review with the following specific activities:
Evaluate the morphological findings in multiple planes
Assess biventricular function with ejection fraction and characterization of wall motion
abnormalities
Use velocity imaging protocols with post-processing to quantify valve function
Evaluate multiple cardiac segments at incremental levels of stress for abnormal wall motion and
viability
Interpret pre and post-contrast images to assess myocardial viability
Evaluate multiple cardiac segments at incremental levels of stress for abnormal wall motion
Compare to all pertinent available prior studies
Dictate report for medical record
Review and sign report
Discuss findings with referring physician
All new cardiac MRI codes were approved by the American Medical Association (AMA) CPT
Editorial Panel and valued by the AMA Relative Value Update Committee. Both committees had
Centers for Medicare and Medicaid Services (CMS) members. Yet in a strange twist CMS has
decided in its final ruling about coverage that all codes which include flow/velocity quantification
(75558, 75560, 75562, and 75564) will not be recognized and will be assigned “noncovered” status.
This decision harkens back to a previous national coverage decision which did not cover velocity
flow mapping under the old cardiac MRI CPT code 75556. Both the American College of
Cardiology and the American College of Radiology are currently appealing this decision. It would
be expected that third party payers who covered the flow/velocity quantification in the past should
continue to reimburse for it with the new codes.