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Radiology Coding Alert

Reader Question:
Medicare Accepts G0254; Private Payers Prefer 78810

Question: My insurer denied a claim when we reported G0254. The payer requested that we submit 78810 instead. Is this correct? Wisconsin Subscriber Answer: The HCPCS code G0254 (PET imaging for breast cancer, full and partial ring PET scanners only, evaluation of response to treatment, performed during course of treatment) is a temporary Medicare code. You should report G0254 to Medicare payers and other insurers that accept these HCPCS Level II codes when your radiologist performs a PET scan for breast cancer imaging. If a private insurer covers your patient, however, you should report 78810 (Tumor imaging, positron emission tomography [PET], metabolic evaluation) instead. You should report this code regardless of the anatomic area that the practitioner imaged, and some insurers may require a report. -- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; and Gary S. Dorfman, MD, FACR, FSIR.

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