Medicare allows billing for whole-body planar or SPECT single-area imaging, but not both

Q.

We did an MIBG scan with whole-body planar images at 24 hours after an injection followed SPECT of the abdomen. Would we assign CPT^® code 78802, CPT code 78803, or both codes? 

A.

According to the rules we’ve had for years, this should be described by CPT codes 78802 (whole-body planar), and 78803 (SPECT single area). However, Medicare has changed the rules, and there is a CCI edit that prohibits billing both, so you can assign either CPT code 78802 or CPT code 78803, but not both, at least for Medicare patients. Other payers may allow both codes, but you would have to check to verify their specific policy.