Oncology & Hematology Coding Alert

Welcome deletion could bring your office thousands in additional revenue

The radiation oncologist performs whole body imaging (78804) and SPECT (78803) on the same day. But Medicare bundles these codes, so you can report only 78804, right? Lucky for you, that's no longer true.

Thanks to the National Correct Coding Initiative (NCCI) edits, version 10.2, which took effect July 1, you can now separately report 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) and 78803 (... tomographic [SPECT]).

The edit is important for oncology and nuclear medicine coders because SPECT (single photon emission computed tomography) is the three-dimensional reconstruction of the nuclear medicine scan, says Cindy C. Parman, CPC, CPC-H, RCC, president-elect of the American Academy of Professional Coders' National Advisory Board and cofounder of Coding Strategies Inc. in Powder Springs, Ga. The oncologist or nuclear medicine specialist can use SPECT to view a diagnostic study's results, she adds. Get Paid for Past Denials Don't give up on those 78804-78803 claims that your Medicare carrier denied earlier this year. You may retroactively bill for 78804-78803 claims that Medicare denied from Jan. 1 to July 1, if warranted, says Denise A. Merlino, CNMT, MBA, FSNMTS, coding adviser for the Society of Nuclear Medicine and president of Merlino Healthcare Consulting Corp. in Stoneham, Mass.

To retroactively bill for denied claims, you have two options, Parman says:

You can run a report and resubmit denied charges.

You may also review imaging reports to determine if the physician performed SPECT and submit new claims. Good news: Your Medicare carrier may pay about $60 for 78803-26 ([SPECT]; professional component). You should attach modifier -26 to represent the radiation oncologist's professional services. Typically, an oncologist reviews and interprets the results or image. Also, on July 1, Medicare increased 78804's RVUs to 11.14, which means you can expect about $428 per 78804-26 charge.

CMS Corrects 'Fast-Track' Error NCCI deleted the 78804-78803 bundle because it implemented the edit on a "fast- track" basis, Merlino says. This means that professional societies, such as the Society of Nuclear Medicine, did not have an opportunity to comment prior to the edit.

"The code pair combination of whole body and SPECT for either bone imaging or tumor imaging has been a normal part of nuclear medicine imaging for many years," Merlino says. Physicians perform several types of whole-body tumor and SPECT studies, including monoclonal antibody imaging with agents, Bexxar or Zevalin, prostascint imaging, and gallium imaging for malignant disease, Merlino says.

For example: The radiation oncologist uses radiopharmaceutical localization to test radioimmunotherapy agents Zevalin and Bexxar. By using  the localization technique, the physician determines whether the radiopharmaceutical will target a patient's tumor or will concentrate [...]