Eunice Posted Fri 16th of November, 2012 13:31:22 PM
Can three phase bone scan (78315) and spect (78320) be billed together?
Referring physician ordered both but insurance is denying claim as mutually exclusive.
SuperCoder Answered Mon 19th of November, 2012 05:29:04 AM
They are not mutually exclusive.This coding issue becomes confused when the situation of pairing 78320 with 78300, 78305 or 78315 arises. In the March 1997 issue of CPT Assistant , for instance, the AMA notes that the bone SPECT code 78320 is not to be used in addition to the other planar bone imaging CPT 78300 and 78305. However, they are not considered mutually exclusive procedures. They are listed in the comprehensive/component section of the CCI edits and carry the CCI modifier indicator of 1, which means that modifier -59 (distinct procedural service) would be appended if billed.
In order to bill these codes with modifier -59, radiology practices must follow the established guidelines for use of this modifier.According to the AMAs general correct coding practices guidelines, modifier -59 would be appended when the scans represent a different session or patient encounter, different site or organ system, or separate lesion or separate injury not ordinarily encountered or performed on the same day by the same physician.