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Remember to examine MRI code descriptors.

When abnormalities develop in the body鈥檚 vascular system, they can change the patient鈥檚 appearance or cause pain and swelling in different parts of the body. Due to the changes in the body, physicians may order imaging tests, such as MRI exams, to visualize the veins to determine the next steps in treatment.

Revenue Cycle Insider put together this helpful guide on venous malformations and how to correctly code imaging tests and the diagnoses.

Understand the Venous Malformation Condition

Venous malformations are veins that form abnormally in the body, and they can either drain into normal veins or stay separate from the normal veins. The malformations occur when veins stretch or enlarge over time, which can result in several symptoms. Venous malformations that are located near the surface of the skin are usually bluish in color and tend to get mistaken for a bruise or a growth under the skin. Deeper malformations can lead to swelling and pain.

The condition is the most common type of vascular abnormality, and can happen almost anywhere on the body, but frequently develops on the head and neck.

Most vascular abnormalities are not passed from parent to child, but there are incredibly rare types of the anomaly that are hereditary. At the same time, many of these conditions are congenital, meaning they鈥檙e present at birth, but the malformations may not become noticeable until later in the patient鈥檚 life.

Examine This Sample Scenario

Scenario: A 35-year-old patient presents to their primary care physician (PCP) with a history of chronic pain and swelling in their left lower leg. The patient鈥檚 PCP performs a physical examination and notes portions of the leg are swollen and tender to the touch. The physician suspects a venous malformation and orders an MRI of the lower extremity without contrast to confirm the diagnosis. A couple of weeks later, the patient visits an outpatient imaging center for an MRI of the lower left leg without contrast. The radiologist confirms a diagnosis of venous malformation in the lower left leg.

Be Mindful of MRI Code Descriptors

When the venous malformation is located deep within the skin, providers can choose to order an MRI to view the veins, the anomalies, and any other affected body structures. Examples of MRI examination code ranges for the head and neck, arms, and legs, depending on contrast use, include:

• 70540-70543 (Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck 鈥�)
• 73218-73220 (Magnetic resonance (eg, proton) imaging, upper extremity, other than joint 鈥�)
• 73718-73720 (Magnetic resonance (eg, proton) imaging, lower extremity other than joint 鈥�)

In the scenario presented, the patient was experiencing chronic pain and swelling in the lower left leg. These symptoms are common with venous malformations deep in the body and not visible on the surface. You鈥檒l assign 73718 (Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)) to report the MRI without contrast.

Important: Pay attention to the code descriptors, as 73718-73720 call out 鈥渓ower extremity other than joint,鈥� whereas 73721-73723 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity 鈥�) specify that the latter codes are designated for MRIs of leg joints, such as the knee or ankle.

Identify the Correct Venous Malformation ICD-10-CM Code

Venous malformations are considered congenital conditions, even though they may not even appear until the patient is an adult. In the ICD-10-CM code book, congenital conditions are listed in Chapter 18 under the Q codes.

Open the Alphabetic Index and turn to Malformation > venous, which will redirect you to Anomaly > vein(s). When you turn to Anomaly and follow the indentations to vein(s) (peripheral), you鈥檙e presented with Q27.9 (Congenital malformation of peripheral vascular system, unspecified) to verify in the Tabular List.

Turning to the Tabular List, you鈥檒l find Q27.8 (Other specified congenital malformations of peripheral vascular system). This code fits the bill for the patient鈥檚 diagnosed condition. While Q27.9 is the code you鈥檙e directed to from the Alphabetic Index, the use of 鈥渙ther specified鈥� in Q27.8鈥檚 descriptor covers the radiologist鈥檚 findings of venous malformation of the lower left leg.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC