Ask Dr. Z

I have run across a couple of situations (post-discharge) where the order and the radiological exam do not match exactly. For instance, a patient came in through the ED with pain that radiated from her abdomen down to left leg with history of pelvic fx last year. Pelvic x-ray was negative and lumbar x-ray w L3 fx indeterm age. So, the physician ordered MRI. The computerized order was for “MRI Lower Extremity Joint Left WO Contrast” (CPT 73721). It doesn’t look like the physician was actually looking for joint pathology. So, based on medical necessity, and the MRI report makes no mention of joints (mentions no fem neck fx or pelvic fx, etc.), it looks like the order should have been for non-joint (as in 73718 or 72195). Ideally, this order should have been corrected at the time of service. As this issue has been found after the procedure was provided and the patient was discharged, what is the best way to compliantly handle this situation? Code 73721 has been denied for medical necessity, and I would like to re-bill this with code3 73718, as this appears to be what the order should have been.