accurate coding of nuclear medicine procedures unravel...

AHRA / RBMA Webinar 9/29/2011

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Accurate Coding of Nuclear Medicine Procedures

Presented by:

D i A M li MBA CNMT CPC

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Denise A. Merlino, MBA, CNMT, CPC

Merlino Healthcare Consulting Corp.

October 4, 2011

Unravel Coding Basics

2October 27, 2009


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Coding Basic Steps

supply

diagnosis

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procedure

Current Procedural Terminology (CPT)

American Medical Association (AMA)

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(AMA)

Category I, II and III Codes

®CPT is a registered trademark of the American Medical AssociationOctober 4, 2011


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CPT Category I Codes

Five Digit Numerical System

Developed and maintained by the American Medical Association (AMA) to describe Medical Procedures.

New Codes released yearly, effective January 1st

Nuclear Medicine Section

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78xxx series Diagnostic & 79xxx series Therapeutic

Healthcare Common Procedure Coding System (HCPCS) Level I

October 4, 2011®CPT is a registered trademark of the American Medical Association

CPT Category II Codes

Alpha-Numerical System

Four Digits followed by letter “F”g yDeveloped & maintained by the American Medical Association (AMA) to describe Performance/Quality Measures.

New Codes released yearly, effective January 1st

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Tracking Codes for Performance & Quality Measures



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AMA CPT Category II - Examples

Nuclear Medicine Quality Measure

CPT Category II

Long Descriptor CommentII

3570F

Final report for bone scintigraphy study includes correlation with existing relevant imaging studies (eg, x-ray, MRI, CT) corresponding to the same anatomical region in question (NUC_MED)Measure #147 in PQRI program.

This new code could be used to report to a payer the presence or absence (with modifiers) in a nuclear medicine bone scintigraphy procedure report, the discussion of the correlation to other relevant imaging studies.

3572F Patient considered to be potentially at risk for fracture in a weight-bearing site (NUC_MED) These two new codes

could be used to report to a payer the potential risk

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a payer the potential risk for fracture and the communications to referring physicians with modifiers.3573F

Patient not considered to be potentially at risk for

fracture in a weight-bearing site (NUC_MED)


AMA Educational Tools CPT Category IIMeasure Description, Specification & Worksheet

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CPT Category III Codes

Alpha-Numerical System

Four Digits followed by letter “T”g yTemporary tracking codes, developed and maintained by the American Medical Association (AMA) to describe emerging technology, services and procedures.

New Codes released twice yearly, effective January 1st

and July 1st each year

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and July 1st each year.

Temporary Tracking Codes for Emerging Technology


CPT® CodeRevised 2009

Key Coding Elements

Long Descriptor

Computed tomography, heart, with contrast material(s),

CPT Category III: Example

0146TCoronary

Arteries Only

including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium

Coronary

Computed tomography, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries

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0147Ty

Arteries & Ca Scoring

tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium

(Do not report 0147T in conjunction with 0144T)

®CPT is a registered trademark of the American Medical Association

NOTE: Effective January 1, 2010, CPT deleted these Category III Cardiac CT and Cardiac CTA codes and replaced with new Category I CPT codes, which are in use today.

October 4, 2011


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AMA CPT Guideline - Introductions

• Specific guidelines are presented at the beginning of each of the sections Thesebeginning of each of the sections. These guidelines define items that are necessary to appropriately interpret and report the procedures and services contained in that section.

11October 4, 2011®CPT is a registered trademark of the American Medical Association

CPT I Unlisted Procedure Code - 99

Nuclear Medicine has Unlisted CPT codes in each section 78X99codes in each section 78X99.

CPT states, “Select the name of the procedure of service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service. If no such procedure or

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service exists, then report the service using the appropriate unlisted procedure or service code.”



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Nuclear Medicine Introduction CPT 78xxx & 79xxx

Nuclear Medicine Introduction:“The services listed do not include the

radiopharmaceutical or drug Diagnostic andradiopharmaceutical or drug. Diagnostic and therapeutic radiopharmaceuticals and drugs supplied by the physician should be reported separately using the appropriate supply code(s), in addition to the procedure code.”

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• Providers use HCPCS LEVEL II supply codes for drugs & radiopharmaceuticals with nuclear medicine procedures


CPT Code Symbols

CPT Symbol

Description

New Procedure (red circle)

Current code revision has resulted in a substantially altered procedure descriptor (blue triangle)

(Green brackets) are used to indicate new and revised text other than the procedure descriptors.

(black plus sign) indicates an add-on code. Add-on codes describe additional intra-service work associated with the primary procedure

(green circle arrow) refers to the CPT Assistant monthly newsletter or CPT Ch A I id ' Vi l b k ith ll f th

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CPT Changes: An Insider's View, an annual book with all of the coding changes for the current year.

(red circle arrow) refers to the quarterly newsletter Clinical Examples in Radiology.



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Nuclear Medicine CPT Category I

CPT Code Range Organized by 9 SystemsPrimarily Organ Based

78000-78099 Endocrine

78102-78199 Hematopoietic, Reticuloendothelial & Lymphatic

78201-78299 Gastrointestinal

78300-78399 Musculoskeletal

78414-78499 Cardiovascular

78580-78599 Respiratory

78600-78699 Nervous

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Healthcare Common Procedure Coding System (HCPCS) Level I

78700-78799 Genitourinary

78800-78999 Other Procedures (Including PET)

79005-79999 Therapeutic


Nomenclature

Terminology: a system of words used to name things in a particular disciplineg p p

• The selection of a word or phrase in CPT is carefully considered by the CPT Editorial Panel:

For example: when or if performed, means that the wording preceding this phrase is part of the procedure, however, if not performed would NOT

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p , , ppreclude you from selecting that CPT code. If there is NO mention, the procedure must be performed to select that particular CPT code.

October 4, 2011


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CPT Structure – Semicolon ;Some procedures in the CPT are not printed in their entirety but refer back to a common portion of the procedure. This is evident when an entry is followed by one or more indentations. This is done in an effort to conserve space.

CPT Code DescriptionCPT Code Description

78300 Bone and/or joint imaging; limited areaCPT Assistant Mar 97:11, Dec 05:7Clinical Examples in Radiology Winter 09:5

78305 multiple areas

78306 whole body

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78306 whole body

78315 3 phase study

78320 tomographic (SPECT)


Basics of Add-On CPT Codes

• Add-ons are never reported alone; they must be reported with one of the primary codes listed in their CPT entry.

• The service described in the add-on must be performed inThe service described in the add on must be performed in the same session as the primary procedure and billed on the same claim.

• Never use the 51 modifier on add-ons; • Medicare won't take a 'multiple procedure' reduction off the fee

because the cut is built into the add-on code.

• Remember that all add-ons follow these rules, and they are marked ith a pl s sign “” in the CPT book

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are marked with a plus sign “” in the CPT book.

Add-On Codeslocated in CPT & Summary in Appendix D



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Nuclear Medicine Add-On CPT Codes

CPT Code Description

78020 Thyroid carcinoma metastases uptake y p(List separately in addition to code for primary procedure 78018)

78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure 78472)

78730 Urinary bladder residual study (List separately in addition to code for primary procedure 78740)

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( p y p y p )


Multiple Studies Cardiac ImagingTwo or More Studies are performed

• Stress Study

• Rest Study

• Redistribution Study

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Note: Prone Imaging is not considered a separate study. Prone imaging can be obtained as part of any one of the three studies mentioned above.

October 4, 2011


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Myocardial Perfusion ImagingCPT 78451-78454

CPT Description78451 Myocardial Perfusion SPECT – Single study

78452 Myocardial Perfusion SPECT – Multiple studiesy p

78453 Myocardial Perfusion Planar – Single study

78454 Myocardial Perfusion Planar – Multiple studies

Key Word (s) Important for Code Choice

NOT part for Code Choice

Planar vs SPECT vs PET

Single Study vs Multiple Study

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g y p y Protocols; Rest/Stress, Stress/Rest, Dual Isotope, prone, Redistribution--- Multiple Day’s (general rule 7-10 days)

Wall Motion and/or Ejection Fraction, First Pass Technique


AMA CPT 2010

Example: Addition CPT 2010

CPT Category I Long Descriptor Comments

78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at

Crosswalk 78465 MPI plus 78478 wall motion & 78480 ejection fraction

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when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

fraction



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AMA CPT 2010

Example Revision: CPT 2010Parenthetical Comment

►(78460–78465 have been deleted To Parenthetical to direct provider to new codes►(78460–78465 have been deleted. To report, see 78451–78454)◄

Parenthetical to direct provider to new codesas 2009 codes have been deleted.

►(Do not report 78472, 78473 in conjunction with 78451-78454, 78481, 78483, 78494) ◄

►(Do not report 78481-78483 in conjunction with 78451–78454) ◄

Code combination restriction clarification:Regarding technique of how you obtain the ejection fraction, it can be by first pass technique or gating, either would be acceptable methods included as part of the new MPI packaged CPT codes. An important note providers can no longer bill separately

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conjunction with 78451–78454) ◄ note, providers can no longer bill separately using CPT 78481 or 78483 for first pass technique on a separate camera with any of the new packaged codes. This is because the first pass study for ejection fraction, if performed, are considered part of the entire MPI packaged code description.


Tips & Terminology for Nuclear Medicine

• Procedures performed over multiple days are typical in nuclear medicine anddays are typical in nuclear medicine and should NOT be coded for each individual day, read the code descriptions carefully.• SPOT or Delayed (on same or next day)

imaging are part of the CPT procedure codes additional coding is not appropriate

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codes, additional coding is not appropriate.

October 4, 2011


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Is the stress test included as part of the MPI or Cardiac NM CPT code(s)?

Answer: NO

CPT IntroductionCPT Introduction

Cardiovascular System (78414-78499) Myocardial perfusion and cardiac blood pool imaging studies may be performed at rest and/or during stress. When performed during exercise and/or pharmacologic stress, the appropriate

t t ti d f th 93015 93018 i

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stress testing code from the 93015-93018 series should be reported in addition to code(s) 78451-78454, 78472, 78473, 78481, 78483, 78491, and 78492.


Stress Test CodesCPT 93015-93018

CPT Description

93015 †Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report

93016 †Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report

93017 †Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report

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93018 †Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only

† Not subject to TC or 26 modifier



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Tips & Terminology for Nuclear MedicineLimited Multiple Whole Body

• Limited is one area

• Multiple can be two or more Areas Imaged or Two or More DAYS – Be Careful

• Whole body is head to toe (almost) for bone scan imaging (CPT 78306) and in CPT; for PET (CPT 78812 78815) i th b f k ll t id thi h f

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78812, 78815) is the base of skull to mid thigh, for PET (CPT 78813, 78816) is top of skull to substantially below the knees usually extending to the feet, for thyroid cancer (CPT 78018) head to below pelvis


Bone ImagingCPT 78300-78320

CPT Description78300 Bone Imaging – Limited Area

78305 Bone Imaging – Multiple Area

78306 Bone Imaging – Whole Body

78315 Bone Imaging – Three Phase

78320 Bone Imaging – Tomographic SPECT

Key Word (s) Importantfor Code

NOT part for Code Choice

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for Code Choice

Code Choice

Planar vs SPECT vs Three Phase vs SPECT

Whole Body vs Limited vs Multiple Protocols; Spot Planar views are included in all types of Bone Imagine--- SPECT and Whole Body is acceptable code pair together



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Tips and Terminology for Nuclear Medicine Coding

• Acceptable code pairs are Whole body and SPECT for Bone or Tumor codes

• Not acceptable pairs are multiple spot (ie limited planar) and SPECT or with Whole body – Considered Unbundling • Spot or Delay Imaging is part of the base code for nuclear

medicine and is not coded separately

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• Triple Phase (flow, BP, Delay) and other codes (ie SPECT) sites should choose to bill only one, the triple phase, or SPECT.

October 4, 2011

Multiple Studies Other

Two or More Studies are performed

• Lung Ventilation

• Lung Perfusion

• Kidney with Drug

• Kidney without Drug

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Requires two dosesNo difference in coding forSingle day protocol versus Two dayprotocols



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AMA CPT® 2012

Additions Lung Imaging FamilyCPT Category I Descriptor Comments

P l til ti i i ( C lk( ) 78586 78587 78579

Pulmonary ventilation imaging (eg, aerosol or gas)

Crosswalk(s) 78586, 78587, 78591, 78593 or 78594 (Collapsed into one simplified code.)

▲ 78580Pulmonary perfusion imaging (eg, particulate)

Crosswalk 78580

78582 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging

Crosswalk(s) 78584, 78585 or 78588(Collapsed into one simplified code.)

78597 Quantitative differential pulmonary Crosswalk New

31CPT ® is a registered trademark of the American Medical Association

78597 perfusion, including imaging when performed

78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed

Crosswalk 78596

Renal CPT Codes

CPT Code Description

78700 Kidney imaging morphology; limited area

78701 with vascular flow78701 with vascular flow

78707 with vascular flow and function, single study without pharmacological intervention

78708 with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)

78709 with vascular flow and function, multiple studies, with and without pharmacological intervention

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p g(eg, angiotensin converting enzyme inhibitor and/or diuretic)

78710 tomographic (SPECT)

78725 Kidney function study, non-imaging radioisotopic study



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AMA CPT® 2012

Additions Hepatobiliary FamilyAdditions Hepatobiliary FamilyCPT Category I Descriptor Comments

78226Hepatobiliary system imaging, including gallbladder when present;

Crosswalk 78220 or 78223

78227

Hepatobiliary system imaging, including gallbladder when present;

ith h l i i t ti

Crosswalk 78223

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78227 with pharmacologic intervention, including quantitative measurement(s)when performed

CPT ® is a registered trademark of the American Medical Association

AMA CPT® 2012

Revision Lymphatic Familyy p yCPT Category I Descriptor Comments

38900New in 2011

Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed(List separately in addition to code for primary procedure)(For injection of radioactive tracer for identification of sentinel node, use 38792)(Use in conjunction with 19302 19307 38500 38510

This is for the injection and probe with blue dye.

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(Use in conjunction with 19302,19307,38500,38510,

38520,38525,38530,38542,38740,38745)

▲ 38792

Injection procedure; radioactive tracer for identification of sentinel node

If imaging is performed, bill 78195

CPT ® is a registered trademark of the American Medical Association


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Radiopharmaceutical Coding

- Every NM Procedure needs at LEAST ONE

- Are BILLED SEPARATELY from the

Procedure

- Are coded using HCPCS LEVEL II codes

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- Are coded using HCPCS LEVEL II codes

October 4, 2011

Healthcare Common Procedure Coding System (HCPCS)

Centers for Medicare & Medicaid S i (CMS)

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Services (CMS)

Level II Codes

October 4, 2011


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Healthcare Common Procedure Coding System (HCPCS) Level II

Single Alpha Four Digit Numerical Coding SystemSystem

Developed and maintained by the Centers for Medicare and Medicaid Services (CMS) to describe medical Drugs, Radiopharmaceuticals, Contrast Agents, Supplies and Procedures

37October 4, 2011

Radiopharmaceutical (RP) HCPCS Level IIDescription Format

Element 1 2 3 4

All RP RP d/ Di ti Billi it If d i ti All RPs are AXXXX Codes

RP and/or radioelement with or without compound and with form if necessary i.e capsule(s)/ solution/aerosol

Diagnostic or Therapeutic

Billing unit, per study dose, per treatment dose, per millicurie (mCi), per microcurie (uCi)

If description, per study dose an “up to” amount is listed for most RPs

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Example: A9503 Technetium Tc-99m medronate

diagnostic (dx)

per study dose

up to 30 millicuries

October 4, 2011


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Myocardial Perfusion Imaging (MPI)Radiopharmaceuticals

HCPCS Trade DescriptionLevel II Name

A9500 Cardiolite® & Generic

Technetium Tc-99m sestamibi, diagnostic, per study dose

A9502 Myoview ® Technetium Tc-99m tetrofosmin, diagnostic, per study dose

A9505 Generic Thallium Tl-201 thallous chloride, diagnostic, per millicurie

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Caution w/ units, thallium round up to highest full mCi administered.Single study one (1) per study dose, multiple studies two (2) doses of Tc labeled or PET MPI Agents.

October 4, 2011

Pharmacological Stress Agents

Document waste,

HCPCS Level II

Description

waste, round up.Look for local MAC policies requiring use of JW

J0152 Inj, Adenosine per 30 mg(do not use J0150 adenosine per 6 mg for ED use)( 90 mg vial and 60 mg vial)

J1245 Inj, Dipyridamole per 10 mg

J1250 Inj, Dobutamine HCL/250 mg

J2785 Inj, Regadenoson per 0.1 mg

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modifier for waste

JW Drug amount discarded/not administered to any patient

Watch Billing Units e.g J2785 (4) units

October 4, 2011


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Other Drugs

HCPCS DescriptionLevel II

p

J0280 Inj, Aminophyllin up to 250 mg

J0460 Inj, Atropine sulfate, up to 0.3 mc

J1160 Inj, Digoxin, up to 0.5 mg

J1265 Inj, dopamine HCL, 40 mg

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J1800 Inj, Propranolol HCL, up to 1 mg

Document waste, round up.

October 4, 2011

Drugs Administered for Nuclear Medicine Procedures are Coded

Separately• With or without Pharmacological

Intervention

• Stress Agents for Cardiac Stress Tests• Adenosine, Dipyridamole, Dobutamine

• Hepatobiliary Imaging• Morphine, Kinevac, CCK, Sincalide

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• Kidney or Brain Imaging• ACE Inhibitors, Digoxin, Lanoxin, Diamox

October 4, 2011


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Medicare Non-Covered PET Procedures

HCPCS Level II

DescriptionLevel II

G0219 PET imaging whole body; melanoma for non-covered

indications Initial staging regional lymph nodes

G0235 PET imaging, any site, not otherwise specified

G0252 PET imaging, full and partial-ring PET scanners only, for initial diagnosis of breast cancer and/or surgical planning

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initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g. initial staging of axillary lymph nodes)

For PET codes that do not currently correspond to any Medicare covered conditions, providers may choose to obtain a signed ABN from the patient.

October 4, 2011

May 2011 HCPCS Preliminary January 1, 2012 Level II Codes

HCPCS Level II Code

Long Descriptor

AxxxxIodine I-123 Ioflupane, diagnostic, per study dose, up to 5 millicuries

Trade Name: DaTscan™ is a radiopharmaceutical i di d f i l d i i li i

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indicated for striatal dopamine transporter visualization using single photon emission computed tomography (SPECT) brain imaging to assist in the evaluation of adult patients with suspected Parkinsonian syndromes (PS).


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Modifiers –Two Digit Letter or Number

A modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or p gcode. Modifiers also enable health care professionals to effectively respond to payment policy requirements established by other entities.

Modifiers may be used to indicate to the recipient of a report that:• A service or procedure had both a professional and technical

component. • A service or procedure was performed by more than one

physician and/or in more than one location. • A service or procedure was increased or reduced

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• A service or procedure was increased or reduced. • Only part of a service was performed. • An adjunctive service was performed. • A service or procedure was provided more than once. • Unusual events occurred.

October 4, 2011

HCPCS Level I & II Modifiers

COMMON

- 26 Professional

OTHERS

- 51 Multiple procedures

- TC Technical

- 59 Separate procedure

- 22 Increased service

- 52 Reduced service

- 77 Repeat Procedure by another physician

- JW Discarded Drugs

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g(See CR 5520 Transmittal 1248 Implemented July 2,

2007 )

Located on inside cover of the CPT Code book & Appendix A



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Nuclear Medicine Coding Issues

Patient does not show up for scheduled procedure and you are left with cost of radiopharmaceutical

- Medicare states that if services are not rendered then you cannot bill. It is the facility choice to decide to bill patient directly, y p y,similar to the dentist.- CMS Instructions for Charges for Missed Appointments

See Transmittal 1279 CR5613

Patient shows up, has radiopharmaceutical and for some reason does not return; or patient becomes ill, or claustrophobic etc

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claustrophobic, etc- Bill for procedure completed, such as limited or can bill with Modifier 52 (reduced service) or Modifier 53 (discontinued service). - In some locations payer systems can not accommodate modifier 52 and payer may instruct you to code for radiopharmaceutical plus appropriate administration code.

October 4, 2011

Nuclear Medicine Coding Issues

• What about using injection and other administration codes?• Resources INCLUDED in most NM procedures• Exceptions: CSF,sentinel node

(lymphoscintgraphy w/o scintigraphy) peritoneal shunts, intra-arterial therapy

48October 4, 2011


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International Classification ofInternational Classification of Diseases - Clinical Modification

(ICD- 9 & 10 CM)Centers for Medicare & Medicaid Services

(CMS)

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(CMS)

Revision 9 & 10

October 4, 2011

(International Classification of Diseases)ICD Codes

• Universal diagnosis codes used by all medical specialties used to describe current problem as well as past history

• Organized by disease state• Used by gov’t to track trends

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(International Classification of Diseases)ICD-9 Codes

• REASON for the procedureREASON for the procedure

• Code to highest level of SPECIFICITYand degree of certainty

• MATCH ICD 9 code to each CPT code

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• MATCH ICD-9 code to each CPT code

October 4, 2011

(International Classification of Diseases)ICD-9 Codes

• How Patient Presented• How Patient Presented

• Related to Definitive Diagnosis

• Signs or Symptoms may be used

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Guidelines Effective October 1, 2007http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf

October 4, 2011


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ICD - Structure

ICD- 9-CM

• 3-5 characters

• First character is

ICD- 10-CM

• 3-7 characters

• Character 1 is alpha• First character is numeric or alpha

• (E or V)

• Characters 2-5 are numeric

• Always at least 3 h t

• Character 1 is alpha

• Character 2 is numeric

• Characters 3-7 are alpha or numeric

• All letters except U

• Always at least 3

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characters

• Use of decimal after 3 characters

• Alpha characters are not case-sensitive

characters

• Use of decimal after 3 characters

• Alpha characters are not case-sensitive

October 4, 2011

ICD-9-CM

54October 4, 2011


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ICD-10-CM October 1, 2013

55October 4, 2011

Hospital Revenue Codes

American Hospital Association (AHA)

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National Uniform Billing Committee (NUBC)

Hospital Tracking Codes for Accounting Purposes

October 4, 2011


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0254 Drugs Incident to Other Diagnostic Tests0255 Drugs Incident to Radiology0340 Nuclear Medicine - General0341 Nuclear Medicine - Diagnostic procedure

Four Digit Numeric Revenue Codes (RC)

0342 Nuclear Medicine - Therapeutic procedureNuclear Medicine - Diagnostic Radiopharm Established Oct 1, 2004Nuclear Medicine - Therapeutic Radiopharm Established Oct 1, 20040349 Nuclear Medicine - Other0350 CT Scan - General0352 CT Body Scan0404 Other Imaging Services - (PET)0480 General Cardiology0482 Stress Test

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0482 Stress Test0636 Drugs requiring detailed coding

Charges for drugs and biologicals (with the exception of radiopharmaceuticals, which are reported under Revenue Codes 0343 and 0344) requiring specific identification as required by the payer.

Intermediary Manual, Part 3, Claims Processing,Transmittal 1875 Feb 7, 2003

Note: Choice of specific revenue code is up to the hospital.For revenue codes, coding to the highest level of specificity is NOT required.

October 4, 2011

AHA – Hospital RC

034X Nuclear Medicine

Charges for procedures, tests and RPs provided by a g p p ydepartment handling radioactive materials as required for diagnosis and treatment.

0341 Diagnostic Procedures0342 Therapeutic Procedures0343 Diagnostic Radiopharmaceuticals0344 Therapeutic Radiopharmaceuticals

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0636 Drugs requiring detailed codingCharges for drugs and biologicals (other than RPs) requiring specific identification as required by the payer.

Note: Choice of specific revenue code is up to the hospital. For revenue codes, coding to the highest level of specificity is NOT required.

October 4, 2011


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Basics of a Charge Master

59October 4, 2011

Charge Description Master Basics

What is a Chargemaster (CDM)?• Department #

• Item #

• CPT/HCPCS Code

• Revenue Code (RC)

Dept # Item # Limited Description CPT/HCPC RC Price Active Code

Deactivation/ Date

302 18490 MPI wall motion 78478-TC 0341 $300.00 N 1/1/2010

302 18491 MPI ejection fraction 78480-TC 0341 $200.00 N 1/1/2010

302 55501 MPI, SPECT, Multiple 78465-TC 0341 $1,500.00 N 1/ 1/2010

302 55523 MPI SPECT MultipleWM&EF

78452-TC 0343 $2,000.00 Y New

• Description • Price

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302 40325 99mTc MIBI, PSD A9500 0343 $120.00 Y

302 40330 201Thallium, Per mCi A9505 0343 30.00 Y

302 60235 Inj, regadenoson, per 0.1 mg

J2785 0636 $80.00 Y

PSD = per study dose

®CPT is a registered trademark of the American Medical Association


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When to Update the CDM

• Minimum Annual Update with Coding Changes, (October thru December).

• Changes in Payer Guidelines or Instructions

• Changes in Technology

• Department Provides New Services or New P d t Li

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Product Lines

• CMS Quarterly Updates (HCPCS & APC) Updates (January, April, July, October)

October 4, 2011

Authoritative Documents & Implementation Dates

62October 4, 2011