Cardiology Coding Alert

Plus: Considering Lexiscan? Discover which HCPCS code applies.Rumor has it that recovery audit contractors have been scrutinizing radiopharmaceutical claims. And with special rules regarding units, invoices, and more, it's no wonder these are a common spot for errors.You can be sure your practice makes the grade by following these guidelines to clean radiopharmaceutical and nuclear medicine claims.Choose the Appropriate RP CodeFiling a claim that includes a radiopharmaceutical (RP) requires a lot more than choosing the proper HCPCS code for the RP. But that doesn't mean choosing the proper code is a snap.Problem: One auditor found that a practice's coders consistently reported A4641 (Radiopharmaceutical, diagnostic, not otherwise classified) instead of the code that described the specific RP used, such as A9505 (Thallium Tl-201 thallous chloride, diagnostic, per millicurie).Solution: Be specific. If a HCPCS code describes the particular drug used, you must use that code instead of something more general.For example, codes A9502 (Technetium Tc-99m tetrofosmin, diagnostic, per study dose, up to 40 millicuries) for Myoview and A9500 (Technetium Tc-99m sestamibi, diagnostic, per study dose, up to 40 millicuries) for Cardiolite are two codes that Sarah Tupper, CMC, coder for Central New York Cardiology in Utica, often sees.Other codes you may need to consider for your claims include A9505 and low osmolar contrast codes Q9965-Q9967.Note that the same rule about reporting a specific code when available applies to stress agents, too. For instance, if you use adenosine, you should use the appropriate adenosine code, such as J0152 (Injection, adenosine for diagnostic use, 30 mg).RP or Stress Agent Unlisted? Not Just Any Code Will DoIf you use an RP or agent that doesn't have its own code, do some research to discover the proper code to report.For example, Tupper's practice is looking into using the stress agent Lexiscan, which doesn't have its own code, Tupper notes. For Lexiscan you would report J3490 (Unclassified drugs), Tupper says.This matches Society of Nuclear Medicine (SNM) advice to report J3490 for Lexiscan in the freestanding facility and physician office setting (www.snm.org/index.cfm?ID=7701&RPID=1981).Hospitals take heed: Note that starting Oct. 1, "HCPCS code C9244 (Injection, regadenoson, 0.4mg) should be used for billing Lexiscan to Medicare in the hospital outpatient setting only," according to SNM.Pay Attention to 'Per Dose' UnitsChoosing the appropriate number of units for most RPs seems simple because the descriptors specify "per study dose."So, for example, if the cardiologist uses 40 millicuries of Myoview for a myocardial perfusion study, you would choose one unit of A9502, which specifies "per study dose, up to 40 millicuries."But real-life tests don't always prove so easy to code. For example, if the cardiologist uses sestamibi (A9500, ... per study dose, up to 40 millicuries) during both the rest and stress portions [...]