Nuclear Medicine Question for the Week of March 21, 2016

Question:

We performed a thyroid scan on a patient in the morning, and later that day I-131 was given for treatment of Grave’s disease. There is a national correct coding initiative (CCI) edit for 78013 and 79005. Is it appropriate to add modifier -59 and bill both? 

Answer

Yes. In the NCCI Policy Manual for Medicare Services, chapter 9, the Centers for Medicare & Medicaid Services (CMS) note the following: 

“If a diagnostic nuclear medicine procedure is performed on an organ and the decision to proceed with a therapeutic nuclear medicine procedure on the same organ on the same date of service is based on results of the diagnostic nuclear medicine procedure, both procedures may be reported on the same date of service utilizing an NCCI-associated modifier

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