Neurology & Pain Management Coding Alert

You can finally ditch the HCPCS G codes when reporting positron emission tomography (PET) scans for Medicare payers.

CMS has bowed to provider pressure and replaced the "G" codes with 11 CPT codes.

Retroactive to Jan. 30, CMS will recognize PET scan codes 78608-78609 (brain) and 78811-78816 (tumor) instead of the dozens of HCPCS codes (G0210-G0234) that providers had to bill previously, according to Transmittal 475, issued Feb. 11.

Non-Medicare payers have been accepting CPT codes for PET scans for years, and providers have been waiting for CMS to catch up.

Question private payers: Watch for CMS to publish more details and instructions on coding PET scans soon, says Denise Merlino, CNMT, MBA, FSNMTS, coding and reimbursement adviser to the Society of Nuclear Medicine (SNM).

And if your private payer is still relying on the G codes, CMS' revised position could persuade the private payer to adopt the CPT codes also. Check with your payers to see if they've got any changes in mind, Merlino says.

Don't forget -26: Recall that when the neurologist provides interpretation for a diagnostic scan only, you should append modifier -26 (Professional component) to the appropriate CPT code.