For the Week of November 23, 2015

Would it be a contrast-only MRI/MRA scan if localizer scans only are done pre-contrast and most of the diagnostic imaging is done only after contrast administration? In other words, would a non-contrast followed by contrast scan code only apply if additional imaging beyond localizers was done after contrast? 

According to ACR Coding Source (July/August 2015), it is not appropriate to report a non-contrast study of any type (CT or MR) based on localizer images only. MRI always involves “localizer” scans to prescribe any scans, contrast or not. Counting the localizer noncontrast images as sufficient for coding purposes as a noncontrast portion of a "without and with contrast" exam would be inappropriate in the absence of diagnostic sequences performed prior to contrast administration. Specifically, the localizer images are not meant to be used as a non-contrast portion of the examination and should not be coded as such.