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Q&A: Rebill rejected claims containing HCPCS code A4641 in order to receive proper payment

APCs Weekly Monitor, May 2, 2008

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QUESTION: We have had claims rejected for nuclear medicine procedures when we report both a procedure and a radiopharmaceutical. The procedure is diagnostic (78195—lymphatics and lymph node imaging) and we report the radiopharmaceutical using with HCPCS code A4641 (radiopharmaceutical, diagnostic, not otherwise classified). Code A4641 appears in the published list of acceptable HCPCS codes for the procedure-to-radiopharmaceutical edits. Do you know what is causing these claims to reject?

ANSWER: CMS issued Transmittal 1301 (CR5665), “Revised Information for PET scan coding” which removed HCPCS code A4641 from the list of tracer codes that are applicable for positron emission tomography (PET) scans. The change was effective on January 1, 2008.

When CMS implemented this change, HCPCS code A4641 was listed as a deleted code in the edits, rather than not reportable with a PET scan CPT code. CMS rejected claims when facilities reported code A4641, even in cases where the procedure billed was not a PET scan. CMS corrected the edit in the April 2008 update to the OPPS. If this problem was occurring in your facility, you should rebill the claims in order to receive payment.

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