72195

MRI Pelvis Without Contrast

Magnetic resonance imaging (MRI) of the pelvis without contrast (CPT code 72195) is a highly sophisticated, non-invasive diagnostic imaging modality that utilizes a powerful static magnetic field, dynamic gradient magnetic fields, and radiofrequency (RF) pulses to generate detailed, multi-planar anatomical images of the pelvic region. Unlike computed tomography (CT), MRI does not use ionizing radiation, making it an ideal choice for repeated assessments or for patients sensitive to radiation exposure. This specific procedure is performed "without contrast," meaning no gadolinium-based contrast agents are administered intravenously during the session. The scan typically covers the area from the iliac crests down to the symphysis pubis, encompassing the pelvic girdle, reproductive organs (such as the prostate, seminal vesicles, uterus, and ovaries), the urinary bladder, distal ureters, rectum, and various neurovascular and musculoskeletal structures including the hip joints and pelvic floor musculature. The technical process involves various pulse sequences, such as T1-weighted imaging for anatomical detail and T2-weighted imaging for identifying fluid or pathology. Short Tau Inversion Recovery (STIR) or other fat-suppression techniques are frequently utilized to highlight marrow edema or inflammatory processes. CPT 72195 is particularly valuable for evaluating benign conditions such as uterine fibroids, endometriosis, adenomyosis, or pelvic floor descent. It also serves as a baseline for oncological staging of prostate, rectal, or gynecological cancers. In orthopedics, it is used to diagnose stress fractures, avascular necrosis of the femoral head, and labral pathology when contrast arthrography is not indicated. The high soft-tissue contrast provided by MRI allows for superior visualization of the zonal anatomy of the prostate and the layers of the uterine wall, which is often not possible with other imaging techniques.

Clinical Indications

  • Evaluation of pelvic pain or masses
  • Staging of pelvic malignancies (prostate, bladder, rectal, gynecological)
  • Detection and characterization of uterine fibroids or adenomyosis
  • Diagnosis and mapping of endometriosis
  • Assessment of pelvic floor dysfunction or prolapse
  • Investigation of congenital uterine or vaginal anomalies
  • Screening for avascular necrosis of the femoral head
  • Evaluation of stress fractures in the pelvic ring or femoral neck
  • Diagnosis of sports hernia or athletic pubalgia
  • Pre-operative planning for pelvic surgery

Procedure Steps

  1. Verification of physician order and clinical indication.
  2. Comprehensive screening for MR-safety (e.g., pacemakers, metallic implants, foreign bodies).
  3. The patient is instructed to change into MR-compatible attire.
  4. The patient is positioned supine on the MRI table with the pelvis centered in the magnet bore.
  5. A pelvic phased-array surface coil is placed over the patient's pelvis to improve signal-to-noise ratio.
  6. Initial localizer (scout) images are obtained in three planes to plan the scan volume.
  7. Execution of multi-planar sequences (axial, sagittal, coronal) using T1-weighted and T2-weighted parameters.
  8. Optional sequences such as STIR, Proton Density, or Diffusion-Weighted Imaging (DWI) are performed based on the protocol.
  9. Quality control check by the technologist to ensure images are free of motion artifacts.
  10. Reconstruction of data and transmission of images to the Picture Archiving and Communication System (PACS) for interpretation.

Coding Guidelines

  • Use 72195 for a pelvic MRI performed without intravenous contrast material.
  • If contrast is administered during the session, refer to CPT 72196 (with contrast) or 72197 (without and with contrast).
  • For a dedicated MRI of a single joint (e.g., the hip), consider 73221, though 72195 may be appropriate if the entire pelvic girdle is scanned.
  • When MRI of the abdomen (74181) and pelvis (72195) are performed during the same session, report both codes and append modifier 51 if required by the payer.
  • The professional component (interpretation) is reported with modifier 26, and the technical component (facility/equipment) is reported with modifier TC.
  • Do not report 72195 for MR Spectroscopy; that is an add-on service.
  • Ensure documentation supports the medical necessity of imaging without contrast, particularly if a previous contrast-enhanced study was recently performed.

Associated ICD-10 Codes