Advanced Search

Radiology Coding Alert

Reader Question:

Medicare Accepts G0254; Private Payers Prefer 78810

Published on Thu Jul 08, 2004

Question: My insurer denied a claim when we reported G0254. The payer requested that we submit 78810 instead. Is this correct? Wisconsin Subscriber Answer: The HCPCS code G0254 (PET imaging for breast cancer, full and partial ring PET scanners only, evaluation of response to treatment, performed during course of treatment) is a temporary Medicare code. You should report G0254 to Medicare payers and other insurers that accept these HCPCS Level II codes when your radiologist performs a PET scan for breast cancer imaging. If a private insurer covers your patient, however, you should report 78810 (Tumor imaging, positron emission tomography [PET], metabolic evaluation) instead. You should report this code regardless of the anatomic area that the practitioner imaged, and some insurers may require a report. -- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; and Gary S. Dorfman, MD, FACR, FSIR.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Radiology Coding Alert

View All