Wiki 78459

[nyyankees]

when billing out a 78459 can you bill out 1 or 2 A9552? I'm under the impression - from our Tech - that we can only bill out 1. Please let me know.

Keith

 

[Davistm]

A9552 is for a "per study dose up to 45 mCi". If you use up to 45 mCi you should report 1 unit. If you use more than 45 mCi up to 90 mCi then you can report 2 units, etc.

However, check the medically unlikey edits [MUE] for A9552. If it is 1, then you will have to use a modifier 76 to bypass the MUE. You bill one line with A9552x1 and one line with A9552-76x1. [According to the CMS MUE web page, FAQ, this is appropriate - now, if only the MACs would get aboard].

Some commercial payers want A9552 and A9552-59. Best to monitor commercial claims and keep a record of what each payer wants.

Terry Davis
CPC