Nuclear Medicine Question for the Week of January 18, 2016

Question:

Question 

I received a denial for HCPCS level II codes A9500 and A9512 on the same claim stating invalid combination. Prior to imaging of the neck and upper mediastinum, we gave two separate injections: 2.7 mCi of Tc-99m as pertechnetate and 25.4 mCi of Tc-99m labeled sestamibi. Do you know why this combination can’t be charged on the same claim?

Answer

The edit exists because pertechnetate is a component of sestamibi (and some other radiopharmaceuticals), and payers don’t want you to break out one code (A9512) for the pertechnetate and another for the MIBI (A9500). 

However, when two separate injections are given, you can code both and add modifier -59 to A9512. According to the NCCI Policy Manual, Chapter 9: 

8. HCPCS code A9512 (Technetium Tc-99m pertechnetate, diagnostic…) describes a radiopharmaceutical utilized for nuclear medicine studies. Technetium Tc-99m pertechnetate is also a component of other Technetium Tc-99m radiopharmaceuticals with separate AXXXX codes. Code A9512 should not be reported with other AXXXX radiopharmaceuticals containing Technetium Tc-99m for a single nuclear medicine study. However, if two separate nuclear medicine studies are performed on the same date of service, one with the radiopharmaceutical described by HCPCS code A9512 and one with another AXXXX radiopharmaceutical labeled with Technetium Tc-99m, both codes may be reported utilizing an NCCI-associated modifier. HCPCS codes A9500, A9540, and A9541 describe radiopharmaceuticals labeled with Technetium Tc-99m that may be utilized for separate nuclear medicine studies on the same date of service as a nuclear medicine study utilizing the radiopharmaceutical described by HCPCS code A9512.  

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