Summer
Networker
- Messages
- 46
- Location
- Cape Coral, FL
Good afternoon everyone:
I'm seeking advice about reimbursement for CPT code 78492 PET (Heart) which is being performed in the physician's office setting.
I'm new to a Cardiology practice and noticed their PET scan services having a denial code CO-59 Charges are reduced/denied based on multiple surgery rules or concurrent anesthesia rules.
With that said, it appears to me we are being paid the same reimbursement as noted under the Medicare OPPS fee schedule and not under the non-OPPS.
A) Would this be part of the multiple imaging procedures TC reduction?
B) Are they considering the TC and professional component as multiple procedures or is it because the CPT code it self represents multi scans? We are performing the stress test with this scan.
C) Is this code falling under the OPPS imaging cap even though it is performed in the place of service 11?
Trying to get a clear understanding of this topic or confirmation that I understand this correctly. Thank you for your guidance.
Summer
I'm seeking advice about reimbursement for CPT code 78492 PET (Heart) which is being performed in the physician's office setting.
I'm new to a Cardiology practice and noticed their PET scan services having a denial code CO-59 Charges are reduced/denied based on multiple surgery rules or concurrent anesthesia rules.
With that said, it appears to me we are being paid the same reimbursement as noted under the Medicare OPPS fee schedule and not under the non-OPPS.
A) Would this be part of the multiple imaging procedures TC reduction?
B) Are they considering the TC and professional component as multiple procedures or is it because the CPT code it self represents multi scans? We are performing the stress test with this scan.
C) Is this code falling under the OPPS imaging cap even though it is performed in the place of service 11?
Trying to get a clear understanding of this topic or confirmation that I understand this correctly. Thank you for your guidance.
Summer