Know the Correct Combination of Nuclear Medicine Bone Scan Codes to Increase Payment- Published on Mon, Jan 01, 2001
When radiologists perform multiple nuclear medicine bone scans on a patient during the same day, coders must understand which combinations of nuclear medicine bone scan codes may be reported and which modifiers may be appended, especially when SPECT is performed in combination with planar imaging.
Its not unusual for multiple diagnostic scans to be done, points out Deepa Malhotra, MS, CPC, director of coding and compliance for Healthcare Information Services Ltd., in Willowbrook, Ill., which provides billing services to more than 200 physician in the Chicago area. Often, a simple study will be conducted, which identifies an abnormality that will be explored further in a separate session. But in these situations, coders often wonder which codes may be reported together, which are considered component codes of a more extensive study, and which modifiers are most appropriate.
Bone scans will generally be ordered to detect bone malignancies (i.e., 170.1, malignant neoplasm of bone and articular cartilage, mandible) and stress fractures (733.16, pathologic fracture of tibia or fibula), or to differentiate between osteomyelitis (730.21, unspecified osteomyelitis, shoulder region) and cellulitis (682.3, other cellulitis and abscess, upper arm and forearm).
The CPT Codes
that prompts most questions is 78320 (bone and/or joint imaging; tomographic [SPECT]). SPECT, which stands for single photon emission computerized tomography, is an imaging technique using radiopharmaceutical and circumferential images, rather than standard planar images to produce three-dimensional images. SPECT has been called nuclear medicines version of 3-D reconstruction, and may be ordered after two-dimensional, or planar, scans have been performed. In addition to 78320, CPT
lists four planar scans in the 2001 manual:
78300 bone and/or joint imaging; limited area
78305 ... multiple areas
78306 ... whole body
78315 ... three-phase study
Typically, 78300 is performed on a single body part, like a knee, while 78305 would assess several body parts, such as the hips and upper legs. The whole body, as described in 78306, includes the head to at least the level of the knees. CPT 78315
CPT 78315 measures vascular flow, blood pool images and delayed static images. In SPECT, images are reproduced by a computer in three dimensions (i.e., transverse, sagittal or coronal views).
Pairing SPECT Imaging With Other Bone Scans
According to the American Medical Association (AMA), the Society of Nuclear Medicine (SNM) and the Medicare Carriers Manual (MCM), only 78306 may be reported with 78320 when they are conducted during the same session. The MCM notes in section 15022 that this code pair is affected by the modifier -51 (multiple procedures) rule. The SPECT imaging is reported with 78320 and will be paid at 100 percent, while the whole [...]
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