Nuclear Medicine Question for the Week of July 25, 2016

Question:

Question:

We are getting a national correct coding initiative (CCI) edit when we charge 78582 – pulmonary ventilation (e.g., aerosol or gas) and perfusion imaging for the V/Q scan procedure, with A9539 and A9540 for radiopharmaceuticals used. Do you have any insights into why this might be occurring?

Answer:

Answer:

Because many hospitals were using the wrong radiopharmaceutical HCPCS codes when they billed nuclear medicine studies, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the Centers for Medicare & Medicaid Services (CMS) worked together to develop edits for radiopharmaceuticals that are not normally used with a particular test.

Looking at your codes, A9539 (technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries) is incorrect for the aerosol DTPA; you should assign A9567 (technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries). There will be no edits when you use this combination (78582 and A9567 + A9540)