Radiology Coding Alert
Medicare Accepts G0254; Private Payers Prefer 78810
Question: My insurer denied a claim when we reported G0254. The payer requested that we submit 78810 instead. Is this correct? Wisconsin Subscriber Answer: The HCPCS code G0254 (PET imaging for breast cancer, full and partial ring PET scanners only, evaluation of response to treatment, performed during course of treatment) is a temporary Medicare code. You should report G0254 to Medicare payers and other insurers that accept these HCPCS Level II codes when your radiologist performs a PET scan for breast cancer imaging. If a private insurer covers your patient, however, you should report 78810 (Tumor imaging, positron emission tomography [PET], metabolic evaluation) instead. You should report this code regardless of the anatomic area that the practitioner imaged, and some insurers may require a report. -- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; and Gary S. Dorfman, MD, FACR, FSIR.
Radiology Coding Alert
- Billing G0338-G0340 With 77300? Not So Fast
NCCI 10.2 bundles scores of radiation oncology codes together, but modifiers can separate many new [...] - ICD-9 Introduces DVT, Bronchitis Codes
You have until Oct.1 to implement the new diagnosis code changes Coders, take notice: Before [...] - Shore Up Your Zevalin Therapy Claims With 78804 or 79403
Understand the different codes for diagnostic and therapeutic procedures When your radiation oncologist or nuclear [...] - You Be the Coder:
Should We Report 47382 for Alcohol Ablation?
Question: Our radiologist performed an ultrasound-guided alcohol ablation of a liver cyst through a catheter [...] - News You Can Use:
New 'T' Codes Replace 74150, 76375 for Virtual Colonoscopy
Category III codes replace less specific Category I codes July 1 has come and gone, [...] - Reader Question:
Want Extra Pay? Keep Extra Documentation
Question: We perform daily monitoring sonograms and report CPT 76830 for them. Should [...] - Reader Question:
Include Pressure Measurement With Catheter
Question: Our radiologist performed a selective catheterization of the renal artery and also ran an [...] - Clarification:
Report 49424 When You Assess Abscess or Cyst
The June 2004 You Be the Coder titled "How Should We Report a G-Tube Patency [...] - Reader Question:
Note Subtle Differences Between 32020 and 32002
Question: How can we distinguish 32002 from 32020? We confuse these two codes all the [...] - Reader Question:
Obtain History From Patient as Exception, Not Rule
Question: In the June 2004 article "ICD-9 V71.89 : It's Not a Quick Radiology [...] - Reader Question:
Medicare Accepts G0254; Private Payers Prefer 78810
Question: My insurer denied a claim when we reported G0254. The payer requested that we [...]
