Neurosurgery Coding Alert

DEXA and PET scans open new diagnostic testing possibilities Neurosurgeons may have a new diagnostic tool on their hands, thanks to new-for-2005 code 76077 (Dual energy x-ray absorptiometry [DXA], bone density study, one or more sites; vertebral fracture assessment).

Physicians can order many different bone density studies, but "at this point in time, DEXA [or DXA] pretty much is the clinical gold standard for measuring bone density," says Jordan B. Renner, MD, professor of radiology and allied health sciences at University of North Carolina School of Medicine in Chapel Hill.

Surgeons can use DEXA to evaluate potential vertebral fractures, and current Medicare policy specifically allows reimbursement for DEXA to scan patients with vertebral abnormalities, such as osteoporosis, osteopenia or vertebral fracture. No Longer Call on G Codes for PET You can forget about G codes (for instance, G0223, PET imaging whole body or regional; diagnosis; head and neck cancer; excluding thyroid and CNS cancers) and instead call on a number of new, site-specific codes for positron emission tomography (PET), two of which are most relevant for neurosurgeons:

78814 - Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (e.g., chest, head/neck)

78815 - ... skull base to mid-thigh. Watch out: There's a good chance people will misinterpret these codes, says Denise Merlino, CNMT, MBA, FSNMTS, the coding and reimbursement adviser to the Society of Nuclear Medicine (SNM), who staffs the SNM Coding and Reimbursement Committee.

You should not report 78814/78815 if the surgeon interprets both a PET and a separate CT, Merlino says. A concurrent CT refers to a study done on specific machines that allow you to do a PET with a concurrent CT for attenuation correction, meaning a more defined PET that produces better images. This technology costs more money, and that's why it needs its own code for reimbursement, she says - especially because a lot more practices are buying these machines.

Recall that when the surgeon provides interpretation for a diagnostic scan only, you should append modifier -26 (Professional component) to the appropriate CPT code (for more information, see "Another Rejected Interp Claim? Here's Why," Neurosurgery Coding Alert, November 2004, pp 83-84).