PET Gains Popularity Among Non-radiologists
As with computed tomography (CT) and magnetic resonance imaging (MRI), there is a growing trend among non-radiologists to own or lease positron emission tomography (PET) equipment.
Data collected using Medicare Part B Physician/Supplier Procedure Summary Master Files for 2002-2007 tallied the number of PET scans performed on owned or leased equipment by various medical specialists, including radiologists. Since 2006, PET use by non-radiologists significantly outpaced that of radiologists.
“Many non-radiologist physicians are going outside the scope of their original specialty training and practice experience by acquiring and leasing advanced imaging equipment such as PET scanners,” said Rajan Agarwal, MD, MBA, lead author of a study published in the March issue of the Journal of the American College of Radiology.
“One of the well-known factors contributing to rising imaging costs is self-referral among non-radiologist physicians which has been shown to result in unnecessary utilization of imaging,” said Agarwal. “This has made imaging one focus of concern as policymakers and third party payers look to cut health care costs.”
Only medically necessary services should be reported. To that end, the nature of the presenting problem, as documented, should support the services rendered; and ICD-9-CM code selection should support the CPT® codes billed.
Code for Owned or Leased Equipment
If you have seen an increase in PET scans using your physician’s equipment, you may be wondering how to account for it.
Generally, if your physician owns the equipment and interprets the results, bill the applicable PET code without modifiers.
When the physician does not own/lease the PET equipment but provides the interpretation only, apply modifier 26 Professional component to the appropriate PET code modifier.
The technical component of a diagnostic service/procedure accounts for equipment, supplies, and clinical staff (such as technicians). Payment for the technical component also includes the practice and malpractice expenses. Fees for the technical component generally are reimbursed to the facility or practice that provides or pays for equipment, supplies, and/or clinical staff. To claim the technical portion of a PET scan only, report the appropriate code with modifier TC Technical component appended.
For more on modifier 26 and TC usage, read “Capture Total Service or Procedure with 26 and TC” on pages 22-23 of February’s Coding Edge.