Current coding problems for a whole-body exam performed along with SPECT or SPECT/CT
Q.
Is it appropriate to submit CPT® codes 78830 and 78802 on the same date of service (DOS)? Is there a way that I can see all of the edits that are still inappropriately active so I can keep track of these claims?
The codes and full description are as follows:
78802 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging
78830 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), single day imaging
A.
Yes, and no. The rule has always been that if a whole-body exam such as CPT code 78802 is performed along with SPECT or SPECT/CT, both codes may be reported. So, you should be able to report both CPT options, 78802 and 78830.
However, the new organization that took over the NCCI edits for Medicare last year caused confusion with several edits, particularly nuclear medicine edits. SNMMI has been discussing these with them since the beginning of last year. While some edits have been corrected, unfortunately, this is one that is still in effect. You cannot use a modifier to bypass the edit.
It is best to contact the SNMMI directly. They had asked last year for people to contact them with CCI edit issues, so they would have a good idea of what is left to be (hopefully) rectified.
They suggested to contact Denise Merlino at merlinohccc@gmail.com and the SNMMI staff at hpra@snmmi.org. We feel this edit, (SPECT or SPECT/CT along with CPT code 78802) is the most troublesome edit remaining.
You can also keep track of quarterly procedure to procedure edits on the Medicare website at https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes