Nuclear Medicine Question for the Week of June 27, 2016

Question:

Question:

We have begun receiving denials for some of our radiopharmaceutical HCPCS codes. Do you know why this might be?

Answer:

Answer:

Beginning in October 2015, Medicare instituted procedure-to-procedure (PTP) edits for some radiopharmaceutical HCPCS level II codes with certain CPT procedure codes. This came about because the Centers for Medicare & Medicaid Services (CMS) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) discovered many claims with incorrect CPT / HCPCS code combinations. Providers should check to make sure that the HCPCS code they bill is the correct code for the material provided.