Learn by Example: Radiopharmaceutical Therapy Coding Scenario

Improve your know-how with this real-life problem
A patient presents to your office for a thyroid scan and uptake because his primary physician suspects he has a toxic multi-nodular goiter. Your physician orders some blood work and a thyroid-imaging scan to secure a definitive diagnosis.
 
Arriving at a diagnosis for radiopharmaceutical therapy is much like doing a puzzle - you have to put the pieces together before you can proceed, says Joseph Borrego, nuclear medicine technologist with Endocrinology Nuclear Medicine in San Antonio.
How Would You Code the Following Situation?
Your physician administers a diagnostic dose of I-123 and completes a single-determination thyroid uptake and scan. The scan results reveal a definitive diagnosis of a toxic multi-nodular goiter (MNG); therefore, your physician goes ahead and plans a radiopharmaceutical therapeutic session with the patient.
 
Six days later, the patient presents back to your office for the isotope therapy. Your physician then administers 30 mci of I-131 and counsels the patient on side effects and the future plan of care.
The Correct Coding
First visit: Report 78000 (Thyroid uptake; single determination) for the thyroid uptake and scan, and report  A9516 (Supply of radiopharmaceutical diagnostic imaging agent, I-123 sodium iodide capsule, per 100 uci) x 2 for the 200 uci of I-123. Also remember to report any appropriate blood draws and lab codes for the blood work the physician ordered.
 
Second visit: Starting Jan. 1, you will report new CPT code 79005 (Radiopharmaceutical therapy, by oral administration) to recoup for all the services on the day you administer the I-131 therapy. Also report A9517 (Supply of radiopharmaceutical therapeutic imaging agent, I-131 sodium iodide capsule, per mci) x 30 for the 30-mci dose of I-131. If the patient has Medicare, remember to attach the drug invoice to your claim.

- Published on 2004-11-21