Isotopes given during Nuclear Procedures

lswindull

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I am trying to ensure we are correctly charging for radio isotopes given during cardiac nuclear procedures. Our fiscal intemediary is TrailBlazer's in Texas. From what I understand this charge should be billed only at invoice.
How are other cardiology practices charging for this drug. Example: A9500 Cardiolite.

Question in Texas.
 

Davistm

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The TrailBlazer web site has specific instructions for reporting radiopharmaceuticals used during nuclear studies. Go to the Home page, choose Fee Schedules, choose Radiopharmaceutical Fee Schedule. Check instructions for providing invoices at the bottom of the page. Blink your eyes, shake your head and think "say what?". [You can contact me per below]

In general, for A9505 and A9502 you must report you invoice cost for the amount of the product used. Both codes are "per study dose up to 40 mCi".
According to CMS, these codes are carrier/MAC priced].

Also see LCD 4C-57AB: Cardiovascular Nuclear Medicine.

I just spent the better part of a week sorting out TrailBlazer radiopharmaceutical coding and billing. Email me at tdavis@ocaheart.com or call 405-608-1207 if you want more information [hint: TrailBlazer does not edit claims per some of the "guidance" on their website].

Terry
 
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