Radiology Coding Alert

Question: We do SPECT imaging of a specific body area after completing another nuclear medicine procedure, and we need to know how to bill both procedures. Is a modifier needed in these cases, or can we just submit both charges by CPT code with no modifier? If a modifier is needed on these, which modifier is needed (see examples below) and what is the proper way to use the modifier for billing purposes?

Example 1: Bone scan (78306) is done first, followed by bone SPECT (78320).
Example 2: Gallium scan (78802) is done first, followed by Gallium SPECT (78803).
Example 3: Renal scan (78707) is done first, followed by Renal SPECT (78710).

Rick Golab
Orlando Regional Medical Center, Orlando, Fla.

Answer: According to Correct Coding Initiative edits, there are no bundling issues in any of the examples provided. Therefore, your practice may bill both. Nor do these pairs of codes for scans need a modifier since they are considered separate examinations.

Code 78306 (bone and/or joint imaging; whole body) is considered bundled with 78300 (bone and/or joint imaging; limited area) and 78305 (multiple areas) per CCI edits. However, it is not bundled with 78320 (tomographic [SPECT]). Therefore, a bone scan (78306) may be billed together with a bone SPECT (78320).

Gallium scans (78802, radiopharmaceutical localization of tumor; whole body) are bundled with 78800 (radiopharmaceutical localization of tumor, limited area) and 78801 (radiopharmaceutical localization of tumor, multiple areas), but not 78803 (tomographic [SPECT]). So, again, a Gallium Scan (78802) and a Gallium SPECT (78803) may be billed together.

Finally, a renal scan (78707, kidney imaging with vascular flow and function; single study without pharmacological intervention) is bundled with related codes 78700, 78701, 78704, 78715 and 78725but not with a renal SPECT (78710, kidney imaging, tomographic [SPECT]) per CCI edits.

Coding tip: Although there are no bundling concerns inherent with these examples, coders should remember that some nuclear medicine procedures like 78306 and 78320 fall under the standard multiple procedure rules for Medicare. Under these rules, standard payment adjustments for multiple procedures reported on the same day will apply. In the bone scan cited above, for example, the SPECT will be paid at 100 percent, while the total body scan will be reimbursed at 50 percent.