Radiology Coding Alert

Question: A question has come up in our practice regarding the use of 78890 / 78891 (Generation of automated data ; simple manipulations and interpretation, not to exceed 30 minutes) and ( complex manipulations and interpretation, exceeding 30 minutes). We are billing the professional component.

When our radiologist performs a SPECT rest/stress myocardial perfusion, gated wall motion and ejection fraction, can he also add a simple computer manipulation (78890) if it is documented in the interpretation? Hospitals don't use this code, arguing that it is bundled into CPT codes used for the exam. I'm not aware of any CCI edits. The radiologist would also like to use 78891 on the PET scans. What are our options?

Mississippi Subscriber

Answer: Although there are no CCI edits that prevent this code from being billed, according to the 2002 Coding & Payment Guide for Radiology Services both are considered bundled services and should not be reported separately. This advice is based on the inclusion of the necessary computer manipulations that are inherent in SPECT imaging. Payment for these services is included in the payment for the exams performed at the same time.

Many practices' experience has shown that the payers do not reimburse separately for these codes. However, if for certain cases additional nonroutine computer analysis of data is performed that is not necessary for the routine interpretation of the study, that additional work is separately reportable by the use of the codes cited.

Unfortunately, many payers still do not honor such submissions. These denials may be appealed with the support of the clinical and procedural information that documents the work above and beyond the normally included services.