Cardiology Coding Alert

Question: I heard that if I perform a SPECT/CT and the CT portion of the system is single-slice, then Medicare says this isn't a diagnostic CT study, and I can't bill for it. Is this true?


Texas Subscriber

Answer: A single-slice CT gives the physician far less information than a stand-alone CT scan, so a payer indicating that you can't charge a single-slice CT as diagnostic makes sense -- but you should ask your individual payers to be sure.

Note: When the physician uses the CT portion of the SPECT/CT for anatomic localization, the Society of Nuclear Medicine (SNM) suggests considering an unlisted-procedure code, such as 78999 (Unlisted miscellaneous procedure, diagnostic nuclear medicine), in addition to the appropriate SPECT code for the fused procedure when the CT is separately ordered, clinically indicated, and if separate interpretations are given.Reason: There is no CPT code to describe SPECT/CT fusion by hardware or software.

SNM emphatically states it does not recommend using a CT code for the anatomic localization CT because it is not a separately ordered diagnostic CT (see the society's Web page http://interactive.snm.org/index.cfm?PageID=5630&RPID=1995).