Radiology Coding Alert

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CMS Says Out With the 'G,' In With the CPT

Published on Wed Mar 23, 2005

Plus: CMS 'unbelievably' ponders a whole new group of edits CMS finally bowed to provider pressure and replaced the tired old "G" codes for positron emission tomography (PET) with 11 CPT Codes.

Retroactive to Jan. 30, CMS will recognize PET scan codes 78459, 78491-78492 (heart), 78608-78609 (brain) and 78811-78816 (tumor) instead of the dozens of HCPCS codes that providers had to bill previously, according to Transmittal 475, issued Feb. 11. CPT 2005 deleted tumor PET code 78810 and replaced it with 78811-78813.

The new transmittal changes the status codes for the CPT codes to "A" (active) or "C," meaning carrier-priced, and adds RVUs for some of them. The 53-page transmittal changes the listed "G" codes to status code "I." Don't miss: CMS added a new G code (G0235, PET imaging, any site, not otherwise specified). Unfortunately, this code has "N" status (noncovered) and no assigned RVUs.

The changes are effective April 4, says Denise Merlino, CNMT, MBA, FSNMTS, coding and reimbursement adviser to the Society of Nuclear Medicine (SNM). Watch for CMS to publish more details and instructions on coding soon, Merlino says. And if your private payer isn't already using these CPT codes, this move by CMS could persuade it, so Merlino suggests you check with your payers to see if they've got any changes in mind.

Note: The transmittal also changes the bilateral status, global period and RVUs of dozens of other codes. You'll find the full transmittal on the CMS Web site www.cms.hhs.gov/manuals/pm_trans/R475CP.pdf. Believe It or Not - New Edits Planned? In other news, CMS announced that it hired AdminaStar Federal to develop new "medically unbelievable" edits (MUEs; transmittal 105, issued Feb. 18). But not long after, CMS sent out a notice that they rescinded the transmittal and would not replace it at the present time.

The edits were supposed to target the usage of particular codes that seem hard to believe, according to AdminaStar's number crunchers.

The National Correct Coding Initiative (NCCI) edits normally list a code in each of two columns. Instead, the new edits would have had a code in column A and a maximum number of code units that you could bill per day in column B.

If CMS does decide to pursue the creation of similar edits, these may simply standardize the existing edits across all carriers.

The changes could be similar to the way NCCI Edits already bundles surgical codes with themselves, meaning they're limited to one unit of each code. We'll keep you posted on any new developments.

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