Billing and Coding: Nuclear Medicine in the 2020 Spotlight

By Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, RCC-IR, CPC, CPC-H
Radiology Today
Vol. 21 No. 1 P. 8

One could argue that the biggest coding changes for diagnostic radiology in 2020 are in nuclear medicine, which is unusual. Needed updates have been made to better reflect the technology being utilized for certain types of exams and ensure codes are available to report services accurately.

Tumor Localization/Inflammatory Process
The existing inflammatory process codes, 78805–78807, have been deleted for 2020, and all of the existing tumor localization codes have been revised to include inflammatory process evaluation and clarification of the technique utilized for the imaging study.

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The existing SPECT codes (78205–78206, 78320, 78607, 78647, and 78710) have been deleted and new codes have been created to cover a broader range of SPECT studies.

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When performed, code 78835 should be assigned with either 78830 or 78832. This code may be reported in multiple units if more than one area is imaged on the same day or if more than one day of imaging occurs.

Myocardial PET
The existing myocardial PET codes, 78459 and 78491, have been revised to include wall motion and/or ejection fraction. The existing code 78492 was revised to indicate a requirement of rest and stress. Other new codes (78429–78431) have been created to define single or multiple studies with concurrently acquired CT. Two new codes, 78432 and 78433, have been created for combined perfusion with metabolic evaluation studies. Finally, a new code for absolute quantitation of myocardial blood flow (AQMBF), 78434, is now available in 2020.

When myocardial perfusion studies are performed during exercise and/or pharmacologic stress, the appropriate stress testing code from the 93015–93018 series may be reported in addition to the appropriate PET code. PET can be performed on either a dedicated PET machine or a combination PET/CT camera. Studies performed on a PET/CT camera include examination of the CT transmission images for review anatomy in the field of view. If a CT is performed for anything other than attenuation correction and anatomical localization, the site-specific CT code should be assigned with modifier 59.

Following is a listing of new and revised codes for 2020. The existing codes for myocardial imaging that did not change should be reviewed to ensure correct code assignment.

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A new year brings new coding changes. For those who frequently perform nuclear medicine SPECT studies and/or myocardial PET scans, this year ushers in exciting changes that allow for the reporting of services that may not have previously been captured. The next step is to see how the payers respond in terms of reimbursement.

— Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, RCC-IR, CPC, CPC-H, is the president of Coding Strategies, Inc, and Revenue Cycle, Inc.