Pharmacy Question for the Week of June 21, 2021

Pharmacy Compliance Question of the Week

Question:

What are the essential elements of radiopharmaceuticals?

Answer:

CMS describes radiopharmaceuticals with three or four elements. The first element is the radiopharmaceutical or radioelement with or without an attached compound and/or administration form, if necessary. The second element identifies if the radiopharmaceutical is used for a diagnostic or therapeutic purpose. This keeps consistent with hospital radiopharmaceutical revenue codes 343 and 344 as well as the CPT® nuclear medicine structure where 78xxx codes are diagnostic and 79xxx codes are therapeutic. The third element describes the billing unit, for example, “per millicurie” or “per study dose.” The final element is only used if the billing unit is per study dose, defining the upper limit of the administered dose and is used to clarify the “dose.”