Nuclear Medicine Question for the Week of January 9, 2017

Question:

Question:

Are radioisotopes and nuclear medicine exams bundled for 2017? I was told that 78805 and A9521 cannot be billed together as they are bundled. In the past, nuclear medicine exams could not be billed without a radioisotope on the same bill.

Answer:

Answer:

Beginning October 2015, Medicare instituted many correct coding initiative (CCI) edits for radiopharmaceuticals with nuclear medicine exams. Medicare and the Society for Nuclear Medicine and Molecular Imaging (SNMMI) found that many facilities were assigning the incorrect HCPCS code for the radiopharmaceutical being used. The SNMMI went through and provided information to CMS regarding which edits to add.

In your case, you probably should report A9569 instead of A9521. Both codes are for Tc-99m exametazime, but A9569 is for white blood cells (WBCs) tagged with Tc-99m exametazime and is used for inflammation or infection imaging. Code A9521 (Ceretec) is used for brain imaging.

A9521 Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
A9569 Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

Medicare no longer denies claims if the HCPCS code for the radiopharmaceutical is not on the claim with the nuclear medicine CPT code, but you should still report the appropriate HCPCS code.