Radiology Coding Alert

Question: How should we bill for radiopharmaceuticals (RPs), since we purchase them by the vial but do not routinely inject each patient with a vial of radiopharma-ceutical? How should we represent only a single dose? Can we charge patients for unused RPs when they don't show up for an appointment and the RP is wasted? Maryland Subscriber Answer: The best way to answer the first question is to refer to the HCPCS codes used for billing RPs. As is apparent in the list of examples below, it is appropriate to bill technetium sestamibi "per dose," technetium tetrofosmin "per unit dose," technetium medronate "up to 30 mci," and thallous chloride "per mci." This list indicates that therapeutic agents are billed similarly, with strontium-89 billed "per mci" and the code for samarium lexidronamm assigned with one unit for each 50 mci. A9500 Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose A9502 ... technetium Tc 99m tetrofosmin, per unit dose A9503 ... technetium Tc 99m, medronate, up to 30 millicurie A9505 ... thallous chloride TL-201, per millicurie A9600 Supply of therapeutic radiopharma-ceutical, strontium-89 chloride, per millicurie A9605 ... samarium sm 153 lexidronamm, 50 millicurie. When billing for RPs, follow both the coding conventions and individual payer guidelines. Commercial payers may require 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) and a copy of the invoice or other verification of the amount of RP administered to the patient. The answer to the second question is more straightforward. It is not appropriate to bill for RPs that are not used during a diagnostic or therapeutic procedure. Patient "no-shows" are a big problem for radiology practices. Many RPs have a short shelf life and may need to be used within hours. When a patient misses an appointment and the agent is not used, it may degrade and be rendered unusable. Unfortunately, this loss is not billable to insurance. Some practices have instituted a "missed appointment" fee that is billed directly to the patient. The use of such fees must be approved within the contract that the practice has with payers.