CPT Code for MRI Abdomen with Gadoxetate Disodium Including Dynamic Multi-Phase and Diffusion-Weighted Imaging
The appropriate CPT code is 74183 (MRI abdomen with contrast material, including dynamic multi-phase imaging and diffusion-weighted imaging when performed).
Code Selection Rationale
CPT 74183 specifically encompasses MRI of the abdomen with intravenous contrast that includes dynamic multi-phase imaging plus diffusion-weighted imaging (DWI), making it the single comprehensive code for this examination. 1
Key Components Included in 74183
Dynamic multi-phase imaging with at least two phases (late arterial and portal venous phases minimum) is mandatory for proper liver lesion characterization 2, 1
Diffusion-weighted imaging (DWI) is explicitly included when performed as part of the protocol 2, 1
Gadoxetate disodium (Eovist) administration as the hepatobiliary contrast agent 2
Hepatobiliary phase imaging at approximately 20 minutes post-injection, which is inherent to gadoxetate protocols 2
Protocol Requirements for Proper Coding
Essential Dynamic Phases
Late arterial phase (approximately 15-25 seconds post-injection) captures maximal lesion enhancement 2, 1
Portal venous phase (approximately 60 seconds post-injection) is required per LI-RADS criteria 2
Hepatobiliary phase (approximately 20 minutes with gadoxetate) provides functional hepatocyte assessment 2
Technical Specifications
Gadoxetate disodium dose: 0.25 mmol/mL (standard hepatobiliary agent dosing) 3
T1-weighted volumetric sequences are typically used for dynamic phases 3
DWI sequences with apparent diffusion coefficient (ADC) mapping improve differentiation of benign versus malignant lesions 2
Clinical Context Supporting This Code
Superior Diagnostic Performance
Gadoxetate-enhanced MRI with dynamic phases plus DWI achieves 87-91% accuracy for liver lesion characterization 2
Addition of DWI to dynamic sequences improves accuracy to 93% with 97% sensitivity for distinguishing HCC from dysplastic nodules 2
This protocol provides 95-99% diagnostic accuracy compared to 71% with CT alone 1
Why This Specific Combination Matters
Dynamic multi-phase imaging alone (without DWI) has lower sensitivity for small lesions <2 cm 2
DWI addition significantly improves detection and characterization, particularly for lesions <3 cm where mean ADC values differentiate benign from malignant 2
Gadoxetate specifically (versus extracellular agents) increases sensitivity from 46-59% to 68-80% for lesion detection 2
Common Coding Pitfalls to Avoid
Do Not Separately Code
Do not bill separately for DWI when it's part of the comprehensive liver protocol - it's included in 74183 1
Do not use 74181 (MRI abdomen without contrast) - this lacks the essential contrast phases needed 1
Do not use 74182 (MRI abdomen without and with contrast) unless the protocol specifically requires pre-contrast T1 sequences for comparison, though this is typically unnecessary with gadoxetate 4
Documentation Requirements
Ensure radiology report documents all acquired phases: arterial, portal venous, hepatobiliary, and DWI sequences 2, 1
Specify gadoxetate disodium by name in the protocol to justify the extended imaging time for hepatobiliary phase 2
Document clinical indication requiring this comprehensive protocol (e.g., liver lesion characterization, HCC surveillance in cirrhosis) 2
Alternative Scenarios
If Hepatobiliary Phase Not Performed
- Use 74182 if only standard dynamic phases (arterial/portal venous) with extracellular gadolinium agent are performed without hepatobiliary phase 1
If DWI Not Performed
- Still use 74183 if dynamic multi-phase imaging with gadoxetate is performed, as DWI is listed as "when performed" in the code descriptor 1