Nuclear Medicine Question for the Week of May 2, 2016

Question:

Question:

What code(s) would we assign for SPECT/computed tomography (CT) scans?

Answer:

Answer:

Other than the following code, there are no SPECT/CT codes.  

78072Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired CT for anatomical localization parathyroid SPECT/CT 

For a gastrointestinal (GI) bleed study with SPECT/CT, the SNMMI suggests assigning an unlisted GI nuclear medicine code (78299) along with the GI bleed study 78278. Presumably then, if SPECT/CT is done in other body areas, then the unlisted code for that body area plus the “regular” nuclear medicine code would be assigned (e.g., 78452, 78499).

78278Acute gastrointestinal blood loss imaging

78299 Unlisted gastrointestinal procedure, diagnostic nuclear medicine

78452Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

78499Unlisted cardiovascular procedure, diagnostic nuclear medicine

Do be aware, however, that SPECT/CT may not be paid. Besides the fact that an unlisted code must be used, some payers specifically note that SPECT/CT is non-covered.  

Aetna, for example, considers SPECT-CT fusion medically necessary for parathyroid imaging in persons with an enlarged parathyroid gland, parathyroid hyperplasia or suspected parathyroid adenoma or carcinoma, and laboratory evidence of hyperparathyroidism (parathyroid hormone >55 pg/ml and serum calcium >10.2 mg/dL). Aetna considers SPECT-CT fusion imaging as experimental and investigational for other indications because of insufficient evidence of its effectiveness.

Anthem considers the use of SPECT/CT fusion imaging to be investigational and not medically necessary for all indications.