Wiki Nuclear Medicine Functional Reporting

[RaeToll]

I have a claim for gastric emptying study (78264) billed with modifiers MG and PO and G1004 (Clinical Decision Support Mechanism). There is also a charge for lab 82962 and contrast agent (A9541).
UHC Medicare denied the claim stating CPT code 78264 requires functional reporting. It's my understanding that G1004 and modifier MG were reported appropriately for functional reporting.

I have read through CMS MLN Matters Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging as well as the AAPC article Advance Imaging Claims Require New Modifiers and G Codes.

I'm lost on what else the denial could be referring to and I would appreciate any guidance.

https://www.aapc.com/blog/48189-advanced-imaging-claims-require-new-modifiers-and-g-codes/

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11268.pdf

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[whatwouldyousay]

Can you share report with us without any PHI? What is the technique and findings?

 

[RaeToll]

Absolutely! Thank you for responding...
EXAM: NM GASTRIC EMPTYING STUDY
TECHNIQUE:
Solid: Following the oral administration of 1 mCi of Technetium-99m Sulfur colloid in a solid egg and toast meal, immediate,
1h, 2h and 4h delayed images of the abdomen and lower chest were obtained in the anterior and posterior projections. The
meal was consumed within a 10 minute period of time. Quantitative analysis was performed, based on geometric mean.
COMPARISON: None
FINDINGS:
At 1 hour, 24% had emptied (normal 10-70%).
At 2 hours, 32% had emptied.
At 3 hours, 47% had emptied.
At 4 hours, 62% had emptied (normal greater than 90%).
The above mentioned normal gastric emptying and retention values are as per the Society of Nuclear Medicine 2009 guidelines
for adult gastric emptying study for solid meals. 2009 by the Society of Nuclear Medicine, Inc. DOI: 10.2967/jnmt.109.067843
Impression:
IMPRESSION:
Severely delayed gastric emptying based on the 4-hour value.