Radiology Coding Alert

Don't let a 78007 slip-up lead to returned claims in 2013.

If you code for vascular flow, thyroid uptake, or other nuclear imaging services, change is in the air. New Correct Coding Initiative (CCI) edits went into effect Oct. 1, 2012, and you'll have new CPT® codes to use starting Jan. 1, 2013.

Don't Double Dip on Nuclear Services

The latest CCI update reveals that denials may be in your future if you report multiple nuclear medicine services on the same claim.

78445: The latest CCI version, effective Oct. 1, 2012, bundles 78445 (Non-cardiac vascular flow imaging [i.e., angiography, venography]) into a large number of diagnostic and therapeutic nuclear medicine codes. In fact, you'll find more than 120 new edits with 78445 in the column 2 position, according to the CCI analysis by Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group. The edits all have a modifier indicator of 0, meaning you may not override them.

You also should be sure to check the CCI edits before reporting multiple nuclear imaging codes for the same body part.

Liver: The latest version of the edits has added new bundles to prevent the reporting of multiple liver and spleen codes together on the same claim. The edits generally bundle codes for static imaging into SPECT imaging codes. For instance, you should not report 78201 (Liver imaging; static only) with 78206 (Liver imaging [SPECT]; with vascular flow).

CSF: Cerebrospinal fluid (CSF) code 78647 (Cerebrospinal fluid flow, imaging [not including introduction of material]; tomographic [SPECT]) is now bundled into four other CSF codes:

• 78630, ... cisternography
• 78635, ... ventriculography
• 78645, ... shunt evaluation
• 78650, Cerebrospinal fluid leakage detection and localization.

Kidney: You also should be sure to check claims against CCI edits before reporting kidney function studies and kidney imaging morphology. There's a good chance you'll discover you shouldn't report the codes together. For instance, you'll find 78707 (Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention) bundled with 78710 (Kidney imaging morphology; tomographic [SPECT]).

Swap Out Your Old Thyroid Imaging Codes

You have a bit of time to prepare for another nuclear medicine change. When CPT® 2013 becomes effective January 1, thyroid imaging will have a new look. Keep in mind: Code changes won't be official until later this year, so revisions are still possible.

Seven thyroid uptake and imaging codes will be consolidated into three new codes:

Parathyroid imaging will look different, too. Instead of having just one code, you'll have three codes to choose from.

CPT® 2013 will revise 78070 by adding the underlined text:

• 78070, Parathyroid planar imaging (including subtraction, when performed).

In addition to making 78070 apply to planar imaging only, CPT® will add two new codes for SPECT imaging:

• 78071, ... with tomographic (SPECT)
• 78072, ... with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization.