From the Chair of the Commission on Economics
Gregory N. Nicola

We live in exciting times, with novel implanted devices and therapies being introduced and providing relief to patients every day. For decades, patients receiving these implanted device therapies were denied access to the powerful diagnostic capabilities of Magnetic Resonance (MR) imaging due to the very real risks of injury, device malfunction or even death. Kudos to the implanted device industry working collaboratively with manufacturers of MR systems to 1) establish new standards for testing implants for MR interactions and 2) redesigning implants to be resilient to the challenges of the MR environment. Many patients with complex implanted devices are now eligible for MR examinations.

But let’s face it, it can require a lot of extra work and expertise to perform MR exams when some of these implants are present. Not every implanted device has been tested. Some devices require that we severely restrict scan durations or how much energy we deposit in the patient. Some require special programming, positioning or immobilization of the implant for the MR exam. The MR instruction manual for the implant is sometimes longer than the surgical instructions. Before any of that detailed work can be done, we need to know exactly what implanted device(s) the patient has, which can also be time-consuming to find.

With recognition of this additional work, the AMA's Current Procedural Terminology (CPT^®) Editorial Panel approved six new CPT codes under a new heading of “Magnetic Resonance Safety Implant/Foreign Body Procedures.” Three codes are for pre-MRI planning and would typically be performed on a date prior to the MRI exam, while the other three codes reflect additional work that may occur on the day of the MRI exam. 

Before any of that detailed work can be done, we need to know exactly what implanted device(s) the patient has, which can also be time-consuming to find.

MR Safety — Planning Prior to the MR Exam (Codes 76014–76016)

Code 76014 MR safety implant and/or foreign body assessment reflects the initial 15 minutes of work for trained clinical staff to identify and verify implant components, review MR requirements of the implant, contact the patient with implant-specific instructions prior to the MR exam, and provide a written summary in the medical record. Contraindications to MR are also documented.  Code 76015 is an add-on code for each additional 30 minutes to perform this work for patients with complex, multiple or incompletely documented implants. Both 76014 and 76015 are technical component-only codes, and do not include physician work. 76015 may be reported up to three times per encounter.

Code 76016 MR safety determination by physician or qualified healthcare professional responsible for the safety of the MR procedure is an additional code for work to plan an ordered MR exam. The work of this code is not anticipated to be used on a routine basis, but rather used for situations where MR requirements may not be clearly identified, MR presents a risk to the patient, or the diagnostic utility of the MR exam may be compromised by the presence of the implant or foreign body. This code is used when a responsible physician reviews the patient’s clinical scenario and the potential utility of diagnostic information from the MR exam, engages a medical physicist for advice on potential risks of performing an MRI and options to mitigate risk, and performs a risk-benefit analysis of performing the requested MR exam. The risk-benefit analysis, along with recommendations for how to perform the exam or suggestions for alternative diagnostic tests, is documented in a written report. Some examples of when this work might be performed include the presence of abandoned lead or lead fragments, non-functioning implants, or devices implanted in unanticipated anatomical locations that have not been tested for MR safety.

MR Safety — Work Performed Day of the MR exam (Codes 76017–76019)

Codes 76017, 76018 and 76019 all include physician work to ensure the patient and the patient’s implant are protected during the MR exam, working together with the clinical staff.  

Certain implanted devices have limits on the radiofrequency energy used or may introduce significant artifacts. If a medical physicist or MR safety expert is present to customize the MR exam due to the implant, Code 76017 MR Safety Medical Physics Exam Customization is used to account for the extra scanner time and interactive work of the medical physicist, radiologist and MR technologist in the care of the patient.

Some implanted devices require programming into an appropriate mode for the MR exam. If that programming occurs in the MR suite, Code 76018 MR Safety Implant Electronics Preparation is used to account for the extra scanner time and knowledge and care for that patient in an altered therapeutic state.

Finally, some implanted devices have special instructions for positioning or immobilizing the implant during the MR exam. Code 76019 MR Safety Implant Positioning and/or Immobilization is used to account for the extra scanner time and care to perform those additional steps.

Codes 76017, 76018 and 76019 are modular and can be billed together if the implanted device requires more than one of the services. 

Implanted devices are only growing in prevalence. You may already know someone with an implanted device who has struggled to schedule or had to travel long distances for a much-needed MR exam. It is my sincere hope the introduction of these new CPT codes will enable more providers to offer these MR safety services — reducing barriers for patients with implants to receive the healthcare they need.