Oncology & Hematology Coding Alert

CMS corrects payment error

As of July 1, when you report 78804 for your radiation oncologist's whole-body radiopharmaceutical localization studies, you should see more reimbursement from your Medicare carrier.

Code 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) now carries 11.47 RVUs, which represents both technical and professional services. If you report only the professional side, you should assign 78804-26 (Radiopharmaceutical...; professional component) and expect about $428.

The payoff: Although local Medicare payment may vary, if you report full code 78804, you should expect about $430. Practices that bill 78804-TC (... technical component) should see about $414.

The reason: When CPT introduced 78804 this year, Medicare assigned it fewer RVUs than radiopharmaceutical code 78802 (... whole body, single day imaging) carries. The problem was, however, that 78802 represents a single day of imaging, while 78804 describes "two or more days."