Coding for thyroid imaging and radiopharmaceutical administration on the same day

Q.

I’m being told I need to assign a modifier if I submit CPT^® codes 79005 and 78014 together. Do you know which modifier I would choose to submit and why?

A.

Because it is not usual to perform do a diagnostic scan and then administer a therapeutic dose on the same day, you have to use a modifier to tell the insurance that this was an unusual circumstance and that you really did, indeed perform both. Based upon CCI edits, you would assign either modifier 59 or XU to CPT code 78014. 

The codes and full descriptions are:

78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

79005 Radiopharmaceutical therapy, by oral administration