5 Steps Secure Payment For Radiopharmaceutical Therapy

You may lose thousands if you don't use A codes to recoup the isotope costs
You can prevent radiopharmaceutical therapy from being a huge drain on your bottom line - but only by adapting to new 2005 codes and working with carriers to ensure reimbursement of the isotope capsules.
 
Radiopharmaceutical therapy, in which the physician treats thyroid conditions with radioactive iodine, is becoming increasingly common in endocrinology practices. But coding guidelines for radiopharmaceutical therapy are elusive at best, leaving many coders wondering where to start. And the deletion of many 79000-series codes in CPT 2005 only makes matters worse.
Know Your Isotopes
To code correctly, you must first understand that there are two different radioactive isotopes physicians use: Iodine 123 (I-123) and Iodine 131 (I-131).

I-123 is commonly used for diagnostic scans, and the physician administers a set dose of 200 microcuries (uci) of I-123 to the patient before performing the thyroid uptake and scan, says Joseph Borrego, nuclear medicine technologist with Endocrinology Nuclear Medicine in San Antonio. I-123 is a gamma emitter, which means it emits very low radiation and is not at all damaging to the thyroid, he says.
 
I-131, on the other hand, is a beta emitter. At higher doses, I-131 emits stronger radiation that damages thyroid tissue. Once the physician determines the patient's specific diagnosis with the uptake and scan, he administers a therapeutic dose of I-131 (measured in millicuries [mci]) to treat the thyroid condition, Borrego says.
 
Dosage varies: Depending on the severity of the patient's thyroid condition, the physician will administer a lower or higher dose of I-131. For example, a patient with hyperthyroidism receives about 10-15 mci, a patient with a hyperfunctioning thyroid nodule receives about 20-29 mci, and a patient with a toxic multinodular goiter may receive up to 29.9 mci.
Master 5 Easy Steps for Payment
To recoup all you deserve for the diagnostic and therapeutic stages of radiopharmaceutical treatment, follow five expert steps:
 
1. Report the appropriate scan and uptake code for the diagnostic scan. Code 78000 (Thyroid uptake; single determination) is a very common service, but there are numerous different scans (78000-78020) your physician may perform.
 
Patients receive the diagnostic dose of I-123 24 hours before the physician performs the scan and uptake, so you only need to report the scan code for services performed on scan day. The cost of administering the I-123 is bundled into the scan code. On the day before the scan, you may report an E/M service if the physician performed one before administering the I-123.

2. Use A9516 to recoup for I-123. Your practice shouldn't have to provide radioactive iodine to patients without proper reimbursement for these expensive isotopes. Report two units of [...]

- Published on 2004-11-21