MRCP is an MRI exam of the biliary system and pancreas that is typically performed without contrast. It includes 3D cholangiographic post processing techniques like MIPs. Proper documentation of the 3D imaging is required to bill additional codes for those images separately from the abdominal MRI code. Specifically, noting that 3D images were obtained on a separate workstation or during the exam supports billing an additional 3D rendering code. Without documentation of the 3D techniques used, only the abdominal MRI code can be billed.

1. Magnetic resonance cholangiopancreatography (MRCP)
 MRCP technique documentation – remember to document 3-D MIP imaging for your 3-D
cholangiographic post processing images
MRCP is an MRI exam of the biliary system and pancreas. The exam is typically performed without
contrast and includes 3D cholangiographic post processing such as MIPS. Since there is no specific CPT
code that describes MRCP, the AMA and ACR have published information regarding the appropriate CPT
code selection.
According to the coding resources, an MRCP includes a standard MRI of the abdomen along with MIP
images to better delineate the bile duct anatomy. Therefore, it is appropriate to report MRCP with
codes for MRI of the abdomen as well as coding separately for the 3-D rendering codes assuming
documentation supports the 3-D imaging.
If documentation lacks information addressing the 3-D MIP imaging on a radiology report, the coder
cannot assign the additional CPT code for these images. By just documenting MRCP in the title of the
exam, or using verbiage stating “MRCP Protocol” without specifying the 3-D imaging will not support the
additional code for these images in the event of an audit.
Below are examples of actual techniques seen on current radiology reports.
TECHNIQUE #1: Abdominal MRI imaging was performed without contrast utilizing MRCP protocol.
This technique allows only the Abdomen MRI (74181) code to be coded and billed.
TECHNIQUE #2: Multiplanar, multisequence magnetic resonance imaging of the abdomen was
performed using MRCP protocol and without the administration of intravenous contrast. 3D volume
rendered reformation images of the biliary tree were obtained on a separate work station and
transferred to PAC's.
This technique allows both the Abdomen MRI (74181) as well as the 3-D reconstruction code performed
on the separate workstation (76377)
TECHNIQUE#3: T1 and T2 sequences were utilized in multiple planes. Additional heavily weighted T2
sequences were used for the M.R.C.P. portion of the examination. 2-D and 3-D multiplanar images were
also obtained
This technique allows both the Abdomen MRI (74181) as well as the 3-D reconstruction code performed
on the same workstation (76376)
T. Galan, CPC -1- 9/20/11
HIS South – Radiology Division MRCP