Radiology Coding Alert

You win some, lose some in eliminating 'per study dose' frustration.

When your practice is spending hundreds of dollars on every vial of Myoview, you know how important it is to get your radiophamaceutical units right. Apply these HCPCS 2009 changes Jan. 1 to keep your accuracy rate looking its best.

If you perform PET scans -- and bill for the radiopharmaceuticals -- don't miss new code A9580 (Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries).

You may see sodium fluoride F-18 used to detect bone diseases and tumors.

In 2008, without a specific code for sodium fluoride F-18, you would have reported A4641 (Radiopharmaceutical, diagnostic, not otherwise classified).

Watch out: Code A9580 joins a list of tricky HCPCS codes with descriptors that include instructions to report one unit "per study dose" and "up to" a certain amount.

The problem: A joint letter to the HCPCS workgroup from the Society of Nuclear Medicine (SNM) and the American College of Radiology (ACR) states that "since the implementation of 'up-to-amount' doses in 2006, we have encountered much confusion among both payers and coders regarding these up-to-amounts. We believe in some cases there is both over and under coding."

Providers get confused about whether to report 2 units when the provider administers 1 mCi over the up-to amount for clinical reasons (the ACR/SNM letter states one unit is more appropriate). And many payers allow only one unit even if the patient has multiple studies.

The letter, signed by Kenneth McKusick, MD, FACR, FACNP, SNM AMA CPT advisor, and Richard Duszak Jr., MD, ACR AMA CPT advisor, supports deleting "up-to" amounts for all radiopharmaceuticals and using only "per study dose" in descriptors.

The HCPCS committee agreed with the SNM and ACR recommendations on removing confusing "up-to" amounts for at least one code. HCPCS 2009 revises the code for Myoview by deleting the phrase "up to 40 millicuries";

• 2008: A9502 -- Technetium TC-99m tetrofosmin, diagnostic, per study dose, up to 40 millicuries

• 2009: A9502 -- Technetium TC-99m tetrofosmin, diagnostic, per study dose.

Impact: You should be able to eliminate some of the math from your Myoview claims in 2009, reporting one unit of A9502 per study, even if the patient receives more than 40 mCi for that one study.

But be sure to watch your payer guidelines. As mentioned above, certain payers consider a rest study and a stress study for one patient to be a single study and may deny a second unit of A9502. Time will tell whether they will change this in 2009.

SNM's say: The SNM/ACR letter applauded the idea of deleting the "up to" amount for myocardial perfusion imaging radiopharmaceuticals.

"The SNM is pleased with the deletion of the up to amount for tetrofosmin [A9502], however we are disappointed that CMS did not extend this to the other myocardial perfusion agent, sestamibi [A9500, Technetium TC-99m sestamibi, diagnostic, per study dose, up to 40 millicuries]," confirms Denise A. Merlino, MBA, CNMT, FSNMTS, CPC, SNM's coding advisor and president of Merlino Healthcare Consulting Corp in Stoneham, Mass.

Resource: You can find the SNM and ACR comment letter online at http://interactive.snm.org/docs/FinalMay12_2008SNM_ACRHCPCS%20meetingfollowup%20(3).pdf.