CARDIAC MRI CPT 75557, 75559,75561 - 75565

CARDIAC MRI


o All requests for cardiac MRI should be sent for Medical Director review.

o MRI may be contraindicated due to metal implants, claustrophobia, BMI >40 kg/m2*

*Am J Cardiol 2009;104:1540-1546

o MRA of the coronary arteries is not yet adequately sophisticated to replace coronary angiography in evaluating coronary disease and should not be  authorized.

** EXCEPTIONS: coronary artery anomalies (refer to CD-8.6 Other   Indications for CCTA in the adult Cardiac Imaging Guidelines) and Kawasaki disease are conditions where MRA is considered useful.

** MRA of the coronary arteries is reported with CPT®76498, unlisted magnetic resonance procedure (e.g., diagnostic, interventional).

** All requests for unlisted studies should be sent for Medical Director review

** Requests must be accompanied by detailed notes describing the procedure and indications.

o NOTE: Many patients with congenital heart disease are adequately  evaluated using echocardiography. Cardiac MRI should be considered if a specific clinical question is left unanswered by another recent cardiac imaging study (usually echo) and the answer to the clinical question will affect management of the patient’s clinical condition.


CODING NOTES: CARDIAC MRI

o 2011 Cardiac MRI CPT® codes:

** CPT®75557 Cardiac MRI for morphology and function without contrast

** CPT®75559 Cardiac MRI for morphology and function without contrast materials; with stress imaging

** CPT®75561 Cardiac MRI for morphology and function without contrast materials, followed by contrast material(s) and further sequences

** CPT®75563 Cardiac MRI for morphology and function without contrast  materials, followed by contrast material(s) and further sequences; with stress imaging

** CPT®75565 Cardiac MRI for velocity flow mapping

o The add-on code, CPT® 75565, describes the cardiac MRI blood flow measurement procedure and, when performed, is to be reported in conjunction with CPT®75557, CPT®75559, CPT®75561, or CPT®75563.

o Per the AMA: Only one procedure in the series 75557-75563 is appropriately reported per session and only one flow velocity measurement (CPT® 75565) may be reported per session.*

 *

 Indications for Cardiac MRI

o Many patients with congenital heart disease are adequately evaluated using echocardiography. Cardiac MRI should be considered if a specific clinical question is left unanswered by another recent cardiac imaging study (usually echo) and the answer to the clinical question will affect management of the patient’s clinical condition.

o Indications for Cardiac MRI in the Congenital Heart Disease and/or Pediatric Population Include:

** Congenital heart disease assessment before and after invasive intervention (e.g. Tetralogy of Fallot, patent ductus arteriosus, platypnea, coarctation of the aorta, atrial septal defects, ventricular septal defects [VSD], pulmonary atresia with VSD, transposition of the great arteries, double outlet right ventricle, heterotaxy syndromes, anomalous pulmonary arteries or veins or anomalous coronary arteries, etc.


** Use one of the following: CPT®75557 or CPT®75561.

** CPT®71555 (chest MRA) may be added if the aorta or pulmonary artery needs to be visualized beyond the root, or if aortopulmonary collaterals, pulmonary veins, or systemic veins need to be visualized.

** Chest MRA alone (CPT®71555) should be performed if the patient cannot cooperate with full cardiac MRI exam.

** Cardiac MRI (CPT®75565 in conjunction with CPT®75557 or CPT®75561) can be used to evaluate for shunting through a VSD if a recent echo has been done, including a bubble study, and there is documented need to perform cardiac MRI in order to resolve an unanswered question.

** Coarctation of the aorta

** Follow-up (surveillance) imaging after repair of coarctation:  Adults (age 18 and older): chest MRA (CPT®71555) every 2 to 3 years and before and after any intervention for re-coarctation Infants and children (below 18 years old): echo every month for several months then echo every 6 months to one year thereafter.

** Typical frequency of follow-up imaging for Tetralogy of Fallot is once a year. More frequent imaging may be necessary if clinical symptoms warrant or if imaging is needed following a new interventional  procedure.

** Clinical suspicion of arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy (ARVD/ARVC), especially if patient has presyncope or syncope if the clinical suspicion is supported by established criteria for ARVD (see PACCD-3 Evidence Based Clinical
Support) or if the patient has documented Brugada’s syndrome. MRI (CPT®75557) is considered the optimal test for this disorder.*

** If right ventricular abnormalities are already identified by echo or other techniques, MRI may not be necessary.

** Young patients with right bundle branch block, unexplained syncope, and “normal” echo can undergo cardiac MRI (CPT®75557 or  CPT®75561) to rule out ARVD/ARVC.

* Circulation 2006;113:316-327

*Am J Med 1994;97:78-88

*Eur Heart J 1989;10:127-132

*Circulation 2005;112(25):3823-3832

** Pericardial disease: (constrictive versus restrictive pericarditis;  perimyocarditis): Report CPT®75561. MRI should not be utilized to ‘diagnose’ pericarditis but only to answer the question regarding possible constriction or restriction suggested clinically or by other techniques.

** Evaluate cardiac tumor or mass: (e.g. in sarcoidosis or tuberous sclerosis). Report CPT®75561

** Anomalous coronary arteries: Cardiac MRI (CPT®75561) or CCTA  (CPT®75574) (which is still favored) is much better at detecting this than conventional angiography

** Fabry's disease: late enhancement MRI may predict the effect of enzyme replacement therapy on myocardial changes that occur with this disease. Report CPT®75561

** Cardiomyopathy

** Cardiac MRI can be performed to evaluate patients with congenital cardiomyopathy (muscular dystrophy, glycogen storage disease, fatty acid oxidation disorders, mitochondrial disorders, etc.)

** Cardiac MRI can be performed in unexplained cases of cardiomyopathy in order to characterize the myocardium.

** Assessment of global ventricular function and mass if a specific clinical question is left unanswered by another recent cardiac imaging study (e.g. echo, etc.) and the answer to the clinical question will affect management of the patient’s clinical condition.

** Cardiac stress perfusion study:  can be considered on a case by case basis for patients with anomalous coronary artery, Kawasaki disease, or other disorder with the potential for coronary ischemia.