Nuclear Medicine Question for the Week of January 25, 2016

Question:

Question 

We had a patient scheduled for a nuclear medicine test. She was injected with the radiopharmaceutical and placed on the table. Before any images were taken, she panicked, saying she was claustrophobic and could not do the test.  Do we charge for the procedure with a modifier 52? Do we just charge the radiopharmaceutical?

Answer

According to SNMMI, a radiopharmaceutical injection begins the exam, so charge the appropriate code for the exam that was to be done with -52 modifier plus the HCPCS for the radiopharmaceutical. 

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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