Radiology Coding Alert

Follow these expert tips for separate diagnostic CT payment

Problem: CMS replaced dozens of HCPCS Codes with CPT Codes in early 2005, and three of the new codes - 78814-78816 - have very specific documentation requirements. Solution: Our PET professionals dispel four common PET/CT myths to clean up your claims and pump up your payment.

Myth #1: If you have documentation of both a PET and a CT, you may report a PET/CT code (78814-78816).

Careful - don't report 78814-78816 (Tumor imaging, positron emission tomography [PET] with concurrently acquired computed tomography [CT] for attenuation correction and anatomical localization ...) if the radiologist performs a PET and a separate CT, says Denise Merlino, CNMT, MBA, FSNMTS, coding and reimbursement adviser to the Society of Nuclear Medicine.

Only use codes 78814-78816 to report studies on machines designed to perform a PET with a concurrent CT done for attenuation correction (producing a more defined PET with better images).

Myth #2: If the radiologist performs a PET/CT along with a diagnostic CT, don't report the diagnostic CT. It's included in the PET/CT code.

Wrong! Because the CT portion of the PET/CT is different from a diagnostic CT, you may report the diagnostic CT.

How to do it: Be sure you have a separate order for the diagnostic CT and proof of medical necessity before you code it, says Stacie Buck, RHIA, LHRM, VP of Southeast Radiology Management in her presentation "Seven Surefire Strategies for Speedy Diagnostic Radiology Pay-Up." And don't forget to add modifier 59 (Distinct procedural service) to the CT code to tell the payer you performed two separate services.

Caution: If the radiologist performs a diagnostic CT on a PET/CT machine that automatically creates a PET/CT image, don't report 78814-78816 for the diagnostic CT, Buck says.

Myth #3: To report codes 78814-78816, you only need documentation that the physician reviewed the combined PET/CT images.

Reality: You need to check off a number of factors before reporting PET or PET/CT.

For codes 78811-78816, your report should include documentation of the following, Buck says:
 

radiopharmaceutical injected
 

physician interpretation of the images and comparison to prior imaging studies
 

abnormality quantification through calculation of standardized uptake value when clinically indicated.

For codes 78811-78813 (Tumor imaging, positron emission tomography [PET] ...), you should also see these additional tasks, Buck says: 

PET data acquisition and reconstruction performed in multiple planes
 

physician review of the study, determining adequacy and whether he needs additional acquisitions.

Codes 78814-78816 require a little more, she adds: 

CT data acquisition and PET data reconstruction in multiple planes
 

physician overlay of PET and CT images - at a computer workstation - to create images for anatomic correlation
 

physician review of three sets of images - PET scans; CT anatomical localization data; and the combined, superimposed images.

Myth #4: Never report FDG along with your PET or PET/CT.

Payers have differing opinions on this one, so check your payer guidelines, Buck says. In general, if your payer doesn't offer specific instructions on whether to report FDG, it's a good idea to code it. Why: Reporting the FDG use helps the payer (especially CMS) collect data on what's involved with PET procedures, Buck says. Bottom line: CPT doesn't specifically mention FDG in these new codes, so unless your payer tells you otherwise, claim the FDG.

What to do: If you code for a physician or independent center, report A4641 (Supply of radiopharmaceutical diagnostic imaging agent, not otherwise classified). For OPPS, report C1775 (Supply of radiopharmaceutical diagnostic imaging agent, fluorodeoxy- glucose f18, per dose).

Don't: Just because you can report FDG doesn't mean you can report an injection procedure, Buck says. Leave that injection code off of your PET claim.