Rev Up Your Claims for Radiopharmaceuticals
Published on Thu Oct 26, 2006
Learn whether you should -- or shouldn't -- round up units
If you're having trouble picking HCPCS codes for radiopharmaceuticals, you're not alone. Here's how to tackle four common challenges and come up with the correct codes every time. Use These Radiopharmaceutical Basics When you're reporting radiopharmaceuticals, you'll report the specific radioisotope or stressing agent and the quantity your cardiologist injects. Choose from the following HCPCS codes:
• J0152 -- Injection, adenosine, 30 mg
• J1245 -- Injection, dipyridamole, per 10 mg (also called Persantine)
• J1250 -- Injection, dobutamine HCI, per 250 mg. HCPCS 2006 revised the A codes for Cardiolite, Myoview and Thallium. The codes for Cardiolite and Myoview now have a specified limit:
• Cardiolite: A9500 -- Technetium Tc-99m sestamibi, diagnostic, per study dose, up to 40 millicuries
• Myoview: A9502 -- Technetium Tc-99m tetrofosmin, diagnostic, per study dose, up to 40 millicuries.
The code for Thallium has a new look, but you will still report it per millicurie:
• Thallium: A9505 -- Thallium Tl-201 thallous chloride, diagnostic, per millicurie.
Example: The physician uses 40 millicuries of Myoview to perform a myocardial perfusion study that merits 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification). If your physician provides the Myoview, report one unit of A9502.
Caution: You should avoid using 78990 (Provision of diagnostic pharmaceutical[s]) because CPT deleted this code last year, says Rehna Burge, radiology and cath lab billing analyst for North Oaks Medical Center in Hammond, La. How to Code Second-Day Stress Test Problem 1: A patient returns to your office on a second day for the stress thallium portion of a SPECT scan because the cardiologist could not complete the test the first day due to scheduling constraints. The cardiologist uses 10 millicuries of thallium.
You should code the session as follows:
• 93015 -- Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report
• 78465
• A9505 x 10. When your cardiologist performs the rest or stress portions of the SPECT scan on two separate days, you should report the test on either the first day or the second day using the full listing of codes (SPECT, wall motion and ejection fraction) plus any medications supplied by your practice.
Keep in mind: The Society for Nuclear Medicine wrote to HCFA -- now CMS -- and received this reply in February 1999:
The Medicare Carriers Manual, Part B, Section 2005, specifies that expenses for items and services other than expenses for surgery and childbirth are considered to have been incurred on the date the beneficiary received the item or service. When we apply this manual provision to the circumstances described in your letter relating to services that cannot be completed [...]
