Radiology Coding Alert

If you assume that CPT 78306 is bundled into 78320, you could be writing off $115 per patient

If denials for planar bone scans performed with SPECT imaging puzzle you, improper pairings of 78300 and 78320 could be at the source. Our experts answer the most pressing questions about these nuclear medicine codes so you can maximize reimbursement for these expensive procedures.
 
Question 1: We performed a limited bone imaging (78300) and a SPECT bone imaging (CPT 78320 ). Can we report both to Medicare?

Radiologists typically perform limited bone or joint imaging on a single body part, such as a wrist, while SPECT allows the physician to reproduce the images in three dimensions using a computer. If the physician identifies an abnormality during the limited bone study, he might further explore the abnormality using SPECT during a separate session.

Coding solution: If the radiologist performs both procedures during separate sessions on the same date of service, you can report both codes, as long as you append modifier -59 (Distinct procedural service) to 78300 (Bone and/or joint imaging; limited area). The National Correct Coding Initiative bundles 78300 into 78320 (Bone and/or joint imaging; tomographic [SPECT]), so if you don't append modifier -59 to 78300, Medicare will deny the claim. If the physician performs both procedures concurrently, however, you cannot report 78300.

Some coders neglect to report both codes together, even if the physician performs both procedures during separate sessions, says Randall Karpf, owner of East Billing in East Hartford Conn. "Insurers don't always take it upon themselves to tell practices when they can and can't use modifier -59 to undo an CCI Edits ," Karpf says. "Plus, Medicare guidelines often advise practices not to report certain codes together, so the practices don't bother to check the NCCI edits to confirm whether or not a modifier is a valid way to report both codes during separate sessions."

The facts: The March 1997 issue of CPT Assistant , for instance, states, "The bone SPECT code 78320 is not to be used in addition to the other planar bone imaging codes 78300 and 78305 (Bone and/or joint imaging; multiple areas)." But the NCCI edit carries a "1" indicator, which confirms that you can use a modifier to separate the services when documentation clearly supports separate patient encounters.

You can recoup about $305 when you report 78320 and about $135 for 78300, increasing your reimbursement significantly if the physician's documentation demon-strates the separate and distinct nature of the two services.

Remember that the Department of Health and Human [...]