Wiki Nuclear Medicine question

[belmontg]

Can anyone help?

I have a nuclear medicine physician trying to bill 90765 (2008 services) with 78195 and 78461. We bill only for the professional services. However, we are told by CMS this is a Part A covered code only. Using modifier 26 is not an option. The doctor feels if she did the infusion she should be able to be paid. Does anyone have documentation or know where I can find documentation on how to bill this?

Thanks
belmontg

 

[kevbshields]

If the provider is "infusing" the radiopharmaceutical, then this code is inappropriate. CPT Rad section clearly spells that the infusion or injection of contrast, or other substance required for the administration of the service is included in the 70,000 series code payment.

What did this physician "infuse" and what was the POS?

 

[belmontg]

Thank you for your help. The physician does the infusion for the procedure in the facility setting.

belmong

 

[kevbshields]

Her professional fees for the reading will be the only "code-able" service in that instance.