Radiology Coding Alert

Nuclear medicine procedures are often used to diagnose and treat an array of thyroid diseases, ranging from Graves disease to hypothyroidism to thyroid carcinomas. Coders must sort through a matrix of variables, notes Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialties.
 
Coders must distinguish between multiple diagnostic and therapeutic services to ensure correct coding and receive proper reimbursement. "It's particularly important to understand the differences between imaging and uptake before reporting a specific code," she says.
 
Note: The table on page 60, "Checklist for Diagnostic Thyroid Scans," can help coders sort through the elements that determine which code to assign.
Diagnostic Thyroid Studies  
Code series 78000-78020 represents diagnostic studies of the thyroid used to evaluate thyroid function, identify congenital abnormalities, assess palpable nodules and detect thyroid cancer. Among the diagnosis codes that support these scans are 784.2 (swelling, mass, or lump in head and neck), 240.9 (goiter, unspecified, enlargement of thyroid), ICD-9 783.2 (abnormal loss of weight), 785.0 (tachycardia, unspecified) and 785.1 (palpitations).
 
During an uptake procedure, the nuclear radiologist administers an oral dose of radioactive iodine or injects 99mTc pertechnetate. The physician measures radiation levels in the thyroid at various times, beginning as early as 20 minutes after administration, up to 24 hours later. "Thyroid uptake produces a numerical value that helps the nuclear radiologist detect and quantify the effects of thyroid disease," Parman explains.
 
Imaging studies, on the other hand, allow the physician to evaluate the location, size and morphology of the thyroid. In some cases, patients receive an intravenous injection of the radiopharmaceutical (RP), with images taken 20 or 40 minutes later. In other cases, the RP is administered orally and images are obtained at six and/or 24 hours.  
 
For either type of scan, coders must also ascertain if  single or multiple determinations were made. Within the diagnostic series, 78006 (thyroid imaging, with uptake; single determination) is most often assigned and represents a procedure with both components, explains Donna Richmond, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists. "This is assigned when the physician measures the uptake once and obtains images," Richmond says.
 
If images and multiple uptake measurements are taken, CPT 78007 (... multiple determinations) should be assigned. "In this case, the nuclear radiologist is measuring the levels of radioactivity two or more times, perhaps at six, 12 and 24 hours following administration of the drug," she says. "This type of study is conducted, for instance, in cases of possible hypothyroidism. The physician is checking the functionality of the thyroid and may not see [...]