Pelvic MRI (with and without contrast)

What it is

The scanner and the body part are the same as any pelvic MRI. What this code describes is that two complete sets of images were made — the first with nothing injected, the second after gadolinium contrast went into a vein. The point is the difference between them. Gadolinium travels in the bloodstream, so tissue with a rich or leaky blood supply lights up on the second set and tissue without one does not. That is the signal radiologists use to say a lump is living tumor rather than old scar, that a fluid collection is an abscess rather than a cyst, or that a treated area has recurred. The unenhanced set is not redundant — things that are naturally bright, such as blood or fat, have to be seen before the dye goes in, or they cannot be told apart from enhancement afterward.

Why it is done

• To characterize a pelvic mass when the question is whether it is active tissue, and how its blood supply behaves
• To stage or restage a known cancer of the pelvic organs, and to look for spread into neighboring structures
• To tell recurrent disease from scarring in someone who has already had surgery or radiation to the pelvis
• To look for an abscess or an area of infection, which typically shows a rim of enhancement
• To assess deep endometriosis or complex inflammatory disease where the extent matters more than the outline

What to expect

An IV line goes into the arm or hand. Many centers check kidney function before giving gadolinium. The first set of images is acquired, the scan is paused while the dye is injected, and imaging continues — some sequences are timed to catch the dye as it arrives. The whole appointment tends to run longer than an unenhanced study, often forty-five minutes to over an hour on the table. The injection itself is usually felt only as coolness in the arm. Afterward the IV comes out and normal activity resumes. A radiologist reads both sets together.

Questions worth asking

• Is the gadolinium itself billed as its own line item on top of the scan, and roughly what is that line worth?
• Does this study need prior authorization, and has it been approved for the with-and-without version specifically rather than the plain one?
• If the pre-contrast images answer the question and the dye is never given, will the bill drop to the without-contrast code?
• Is a screening blood test for kidney function being done first, and is that billed as a separate lab charge?
• Is there a facility fee here in addition to the scan charge and the radiologist's reading fee?