Health Information Management

Q/A: Coding for free radiopharmaceuticals

APCs Insider, May 6, 2011

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Q: Medicare is rejecting our outpatient claims because we are not reporting a radiopharmaceutical with a nuclear medicine procedure. We received the product for free. Can we bill for this?

A: CMS established a device-to- procedure edit for nuclear medicine procedures. When a hospital charges for a nuclear medicine procedure or imaging, it must also include a separate charge line item for the radiopharmaceutical.

Because a radiopharmaceutical might be provided to the hospital at no cost or with full credit, CMS extended the application of modifier –FB (item provided without cost to provider, supplier, or practitioner, or credit received for replacement device) to this scenario.

Report the HCPCS code and a token charge ($1.01 or less) for the radiopharmaceutical and apply modifier –FB to the nuclear medicine procedure. The modifier will bypass the edit and CMS will know the hospital used a radiopharmaceutical, but the vendor or manufacturer provided it at no cost. For more information, see Transmittal 2130, January 2011 update of the OPPS.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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