Radiology Coding Alert

Prepare for a change in the units box when reporting these codes

Good news if you've been struggling to report radiopharmaceuticals: The new HCPCS manual includes a major shift in the descriptors for these agents, focusing on study doses instead of individual millicuries or microcuries.

"Providers often purchase and administer radiopharmaceuticals not by the number of millicuries or microcuries but by the dose," says Denise Merlino, MBA, CNMT, FSNMTS, coding adviser for the Society of Nuclear Medicine. The new codes simplify your coding, allowing you to report the agents in a way that's more in line with how you purchase and use them.

Example: In 2005 you reported Technetium Tc-99m mebrofenin (choletec) per millicurie with code A9513 (Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc-99m mebrofenin, per mci). In 2006, report A9537 (Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries) per study dose, instead.

"CMS also eliminated the per-vial description, which was very difficult for some providers to use," Merlino says. Why: Providers often take several doses from one vial, so per-vial descriptors led to coding troubles, she says.

Action plan: Update your system to include these new codes, including old codes that have new descriptors, and pay careful attention to your units while you adjust to these new descriptors.
 
Find the full list of new codes on the CMS Web site at www.cms.hhs.gov/providers/pufdownload/anhcpcdl.asp.

Tip: If you download the file as a spreadsheet, you can sort the data to quickly see the codes added, deleted or changed in 2006. Example: Sort the data by column AV ("Termination Date") to group all of the deleted codes.

Here are two examples of how you'll have to adjust your coding for services on or after Jan. 1, 2006:

Example 1: Zap Zevalin Coding Problems

Physicians may use localization to determine whether a radiopharmaceutical will target a patient's tumor or will concentrate in critical organs, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

Take a look at one way that coding for tumor localization with Zevalin changed for 2006:

You typically report 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) when the physician localizes a tumor or distributes Zevalin throughout the whole body. You may also report the Zevalin.

2005 method: Physician offices and imaging centers reported A9522 (Supply of radiopharmaceutical diagnostic imaging agent, indium-111 ibritumomab tiuxetan, per mci). Hospitals reported C1082 (Supply of radiopharmaceutical diagnostic imaging agent, indium- 111 ibritumomab, tiuxetan, per dose).

2006 method: Report A9542 (Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries) for both hospitals and physician offices, experts say.

Documentation tip: Include the complete interpretation and report, which should record who performed the injections and how long the study took.

Careful: The physician may use Zevalin for monoclonal antibody therapy, and you should report this supply with a separate HCPCS code:

2005 method: Physician offices and imaging centers reported A9523 (Supply of radiopharmaceutical therapeutic imaging agent, yttrium 90 ibritumomab tiuxetan, per mci). Hospitals reported C1083 (Supply of radiopharmaceutical therapeutic imaging agent, yttrium 90 ibritumomab tiuxetan, per dose).

2006 method: Report A9543 (Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries), regardless of whether you code for a hospital or physician office, experts say.

Example 2: Update Myocardial Imaging Agent Codes

The agents you use for single-photon emission computed tomography (SPECT) myocardial perfusion studies are keeping their codes, but the descriptors have had a bit of an adjustment.

Here is how the codes looked in 2005:

• Cardiolite: A9500--Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose

• Myoview:  A9502--Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m tetrofosmin, per unit dose

• Thallium: A9505--Supply of radiopharmaceutical diagnostic imaging agent, thallous chloride TL-201, per millicurie.

In 2006, 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.