Radiology Question for the Week of April 25, 2016

Question:

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

Answer:

Beginning in October 2015, Medicare instituted procedure to procedure (PTP) edits for some radiopharmaceutical HCPCS 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. 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.