The 5 Pitfalls of Coding in Nuclear Medicine, Diagnostic Radiology and Interventional Radiology Services

Webinar Q&A

Question 1: 

How do we code when they do planar and SPECT images during the same encounter? We are running into a lot of issues with edits for these code combos, such as 78802 and 78803, sometimes they do whole body planar imaging, then a SPECT study of a single area. 

Answer:

This is still a problem as of today (June 4, 2020) per CCI edits.  We agree that this is incorrect, but the edit itself has not been revised.  Part of the issue may be related to this statement in the narrative instructions in the 2020 iteration of CCI.  This is found in Chapter 9, Section G:  2. Single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. Several nuclear medicine CPT codes describe combinations of planar, single photon emission computed tomography (SPECT), flow imaging, or SPECT with CT imaging for evaluation of a specific anatomic area. Unless specified by a single code that combines two or more imaging modalities, no additional information is procured by obtaining both planar and SPECT studies for a limited anatomic area. 

 

Question 2:

Would it be accurate to bill 78803 and 78802 in same session? 

Answer:

While it is an accurate representation billing when both a whole body and SPECT procedure are performed at the same encounter, be aware that CCI still has an edit that precludes this and there is CCI narrative information that speaks contrary to this method of coding.  We agree that this is incorrect, but the edit itself has not been revised.  Part of the issue may be related to this statement in the narrative instructions in the 2020 iteration of CCI.  This is found in Chapter 9, Section G:  2. Single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. Several nuclear medicine CPT codes describe combinations of planar, single photon emission computed tomography (SPECT), flow imaging, or SPECT with CT imaging for evaluation of a specific anatomic area. Unless specified by a single code that combines two or more imaging modalities, no additional information is procured by obtaining both planar and SPECT studies for a limited anatomic area. 

Question #3

When performing myocardial PET, is a regular myocardial stress test performed also or can it be? 

Answer:

If ordered, performed and documented, per CPT Manual instructions, “When performed during exercise  and/or pharmacologic stress, the appropriate stress testing code from the 93015-93018 series may be reported in addition to 78430,78431, 78432, 78433, 78451-78454, 78472, 78491-78492”. The Myocardial PET or PET/CT codes in this instruction are 78430-78433 and 78491-78492. 

Question 4:

Do you have any info regarding A9503 and CPT 78306?  It is hitting CCI edit and you cannot override this.  Usually CMS requirement to code for radiopharmaceutical with procedure.  This pair hits cci without modifier option. 

Answer:

This was a problem, but this edit was inactivated as of April 1.  This was not clearly communicated to all users from CMS.  Please see attached screen shot demonstrating the rescinding of this edit.  The “9” CCEMI indicates that this edit was rescinded retroactive to January 1, 2020.  We would recommend that you rebill those claims that were (incorrectly) denied. 

Question 5:

Also for radiopharmaceuticals , if the product has per dose as billable unit and the per dose is up to certain amount, how do you bill if the actual amount given exceeds the up to number within the per dose description?

Answer:

That is a great question- That is the point of the “per study dose” designation. If the description says “up to 30 mCi” whether you administer 5 or 35 mCi, it is still 1-unit of the code.  If it says per “study dose” and you provide 4 injections of the same material at the same encounter (thing of multiple syringes of lymphoseek or filtered sulfur colloid for a sentinel node study), this is one study, even if the “dose” was divided into 4 different syringes.  If you were doing a SPECT myocardial perfusion exam and you gave one injection of Sestamibi at stress and imaged and then 4 hours later the patient returned and you gave another injection of Sestamibi for rest imaging, these are two different “studies” and per the definition of Sestamibi (See HCPCS code A9500, Technetium tc-99m Sestamibi, diagnostic, per study dose), this would be submitted twice as two separate “studies” were done. 

Question 6:

Revenue rules-based tool – is this something that only you use or is this available for use by providers if we want to run the tool ourselves? 

Answer:

Yes we use, but as a user, the beauty of the system is we can train you all to also write and run your own rules as well. 

Question 7:

[I am] not completely understanding bundling vascular radiology services. 

Answer:

Bundling for vascular IR changes according to the procedure being performed.  It is important to understand the anatomy and the directives/parentheticals.  Some of the procedures are totally bundled, such as intravascular vena cava filter insertion, repositioning and removal.  Other procedures bundle the surgical code and the guidance code together but allow for coding of catheterizations and diagnostic angiogram.  Embolization codes are a good example of this.  Lastly, there is component coding still allowed which means the surgical codes and the radiologic S&I codes are separately reported.  A good example of this type of coding is visceral angiograms.  Hope this helps. 

Question 8:

Can you bill Fluoroscopic guidance (CPT 77001) for a tunneled catheter removal (CPT 36590) when they take still images using the fluoroscopic machine? 

Answer:

You are able to report 77001 with 36590 as long as all of the requirements are met.