Radiology Question for the Week of May 17, 2021

Radiology Compliance Question of the Week

Question:

We did an MIBG scan with whole-body planar images at 24 hours after an injection followed SPECT of the abdomen. Would we code 78802, 78803, or both?

Answer:

According to the rules we’ve had for years, this should be 78802 (whole-body planar), and 78803 (SPECT single area). However, Medicare has changed the rules, and there is a CCI edit that prohibits billing both, so you can code either 78802 or 78803, but not both, at least for Medicare patients. Other payers may allow both codes, but you would have to check with their policy.

78802 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging
78803 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis), single day imaging

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