CPT Code for MRI Complete Spine with Contrast
The CPT code for MRI of the complete spine with contrast is 72159 (MRI spine without contrast followed by contrast and further sequences) when performed as a single comprehensive study, though this is rarely the appropriate clinical approach based on current imaging guidelines.
Important Clinical Context
The provided evidence does not contain specific CPT coding information, as the studies focus on clinical appropriateness rather than billing codes. However, the clinical guidelines reveal critical information about when complete spine MRI with contrast should be ordered:
When Complete Spine MRI With Contrast Is Appropriate
MRI complete spine WITHOUT AND WITH contrast (not contrast alone) is the clinically appropriate study in specific scenarios:
- Suspected infection, inflammation, or neoplasm in pediatric patients with back pain and clinical red flags 1
- Screening for spinal neoplasms in patients with genetic predisposing conditions like NF2-related schwannomatosis, where surveillance every 2-3 years is recommended 1
- CSF leak evaluation as the gold standard initial imaging, where the contrast component demonstrates dural enhancement and engorged epidural venous plexus 2
- Positive radiographs suggesting disc-space narrowing, endplate irregularity, bone destruction, or spinal canal widening in children 1
Critical Caveat: Contrast-Only Studies Are Not Appropriate
The ACR guidelines explicitly state that MRI complete spine WITH contrast ONLY (without the non-contrast component) is rated as "usually not appropriate" (rating of 1) across all clinical scenarios 1. The non-contrast sequences, particularly fluid-sensitive T2-weighted and STIR sequences, provide the most critical diagnostic information 2.
Proper Ordering Approach
When ordering complete spine MRI with contrast, you should specify:
- "MRI complete spine without and with IV contrast" - This ensures both non-contrast and post-contrast sequences are obtained
- The contrast component is added to the non-contrast study when there is concern for infection, inflammation, tumor, or vascular abnormalities 1
- Precontrast images are essential to assess enhancement properly 1
Common Pitfall to Avoid
Do not order "MRI complete spine with contrast only" - this provides inadequate diagnostic information and is considered inappropriate by imaging guidelines 1. Always include the non-contrast component when contrast is indicated.