Oncology & Hematology Coding Alert

The key is knowing the thyroid cancer's site

If you're unclear on when to report radiopharmaceutical codes 79030 and 79035, knowing whether the physician treated a primary or metastasis thyroid cancer will help determine the code you choose.

Remember that 79030 (Radiopharmaceutical ablation of gland for thyroid carcinoma) represents an ablation of a primary thyroid cancer, says Nan Schellhaas, RT, radiology coordinator at Pendleton Memorial Methodist Hospital in Dallas. But you should report 79035 (Radiopharmaceutical therapy for metastases of thyroid carcinoma) when the radiation oncologist ablates a metastasis (or the spreading of) thyroid cancer.

1. Use 79035 to Represent Metastases

"The most common sites for metastases of primary thyroid cancer are generally the lungs and thorax areas," says Jacqui Szymanski, RT, a radiology technologist at Associated Imaging Specialists in St. Charles, Ill.

Will the insurer become suspicious when it determines that you treated thyroid cancer in a site other than the thyroid? No, Szymanski says.

Although the cancer originated as malignant thyroid cells then spread throughout the body, the "new" cancer site is secondary lung neoplasm (196.1, Secondary and unspecified malignant neoplasm of lymph nodes; intrathoracic lymph nodes). Your oncologist should list 197.0 (Secondary malignant neoplasm of respiratory and digestive systems; lung) as the first diagnosis and 193 as the secondary diagnosis to indicate that the primary cancer is thyroid cancer.

2. Always Report the Dose

In addition to reporting either 79030 or 79035, you should also seek reimbursement for the drug your physician administered, Schellhaas says.

"You can report CPT code 79900 (Provision of therapeutic radiopharma-ceutical[s]) in conjunction with both 79030 and 79035 to procure and provide the iodine-131 to the patient," she says. "Code 79900, however, is generally replaced with HCPCS code A9517 (Supply of radiopharmaceutical therapeutic imaging agent, I-131 sodium iodide capsule, per mci) by Medicare carriers."

Other insurers may require the HCPCS code, or they may prefer 79900. You should check each individual payer's requirements. Reimbursement for the drugs
varies, depending on the amount of the radionuclide needed to either ablate the thyroid gland or treat the metastases, Schellhaas says.

3. You Can Report E/M Codes

Because radiation oncologists often administer thyroid ablation radiopharmaceuticals in large doses, your physician may hospitalize the patient for 48 to 72 hours or more.

If this is the case, you should report a hospital admission (99221-99223, as appropriate for the level of care) in addition to the radiopharmaceutical therapy codes.

The National Correct Coding Initiative (NCCI) does not include any edits that bar oncology practices from reporting a hospital admission or subsequent hospital care code (99231-99233) with the therapy.

Therefore, you can report both the E/M visit and 79030/79035 if you have documentation to show that both are medically necessary and distinct from one another.

Your carrier may require you to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code if you report it with 79030 or 79035. This modifier tells the payer that the E/M service is separate from the nuclear medicine procedure.

4. Review the Operative Note

Suppose your radiation oncologist gives you this procedural note for his most recent thyroid cancer procedure: