Q&A: Report diagnostic radiopharmaceutical HCPCS code with nuclear medicine procedure
APCs Weekly Monitor, August 22, 2008
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
QUESTION: We perform a therapeutic thyroid treatment (code 79005) with radiopharmaceutical Iodine I-131 (A9517). Seven to 10 days after the treatment, the patient returns for a diagnostic scan (code 78018) only. Physicians use no additional radiopharmaceuticals during the second visit. Software edits in place for the second visit indicate that the “claim lacks radiopharmaceutical.” If we don’t use one, why must we bill one?
Effective January 1, 2008, the I/OCE will begin editing for the presence of a diagnostic radiopharmaceutical HCPCS code when a separately payable nuclear medicine procedure is present on a claim. Hospitals are required to submit the diagnostic radiopharmaceutical on the same claim as the nuclear medicine procedure. Hospitals are also instructed to submit the claim so that the services on the claim each reflect the date the particular service was provided. Therefore, if the nuclear medicine procedure is provided on a different date of service from a diagnostic radiopharmaceutical, the claim will contain more than one date of service. The nuclear medicine procedure-diagnostic radiopharmaceutical edits are available on the CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/under downloads. Failure to pass these edits will result in the claim being returned to the provider.
CPT code 78018 is on the list of procedures requiring you to report a radiopharmaceutical. Report HCPCS code A9517 on the claim with code 78018 for the claim to be accepted for payment. We suggest that each individual facility create a process to ensure that both codes are billed on the same claim.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Comments
0 comments on “Q&A: Report diagnostic radiopharmaceutical HCPCS code with nuclear medicine procedure ”
Related Products
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- Topic: CMS, OESS post new security compliance review information, checklist
- HIPAA Q&A: Level of encryption needed for email
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Follow CMS' coding guidelines when using modifier -25
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- CMS has reformulated payments for some bilateral procedures
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- ED-to-inpatient transfers are flawed with safety gaps
- Searched