October 31, 2004

ACR Radiology Coding Source™ Sept-Oct 2004 Q and A

Q: What code(s) should be reported for the evaluation of a patient and administration of an initial treatment dose of I-131 for hyperthyroidism?

A: Currently, CPT® code 79000 (Radiopharmaceutical therapy, hyperthyroidism; initial, including evaluation of patient) is used to report the initial therapeutic dose of I-131 in the treatment of hyperthyroidism. As noted in the descriptor, evaluation of the patient is included in the procedure and is not coded separately. However, the type of radiopharmaceutical supply used is reported separately with a HCPCS Level II code (e.g., A9517, A9530) or CPT® code 79900 (Provision of therapeutic radiopharmaceutical(s)).

As of January 1, 2005, submit code 79005 (Radiopharmaceutical therapy, by oral administration) to report the treatment of hyperthyroidism with an orally administered dose of I-131 sodium iodide. Note that unlike 79000 (Radiopharmaceutical therapy, hyperthyroidism; initial, including evaluation of patient), which includes the evaluation of the patient, neither 79005 nor any of the other therapeutic codes include evaluation and management services. Although dose calculation and a discussion of risks and benefits of radiotherapy are included in CPT® code 79005, it is appropriate to report an evaluation and management code when additional services are provided and documented related to the clinical workup of the patient and the decision to treat with radioiodine. Evaluation and management code selection should be in compliance with CPT® requirements. In 2005, a HCPCS Level II code should be submitted to all payers to report the radiopharmaceutical supply used since the CPT® codes 78990 and 79900 have been deleted from the CPT® book. Check Medicare and other third-party payer notifications on their guidelines for the use of these codes.

Note that if a second treatment dose of I-131 for hyperthyroidism needs to be given, there is no code to describe an additional dose, as previously described by 79001(subsequent, each therapy); therefore, reporting of 79005 (Radiopharmaceutical therapy, by oral administration) for the second therapeutic dose of I-131 would be appropriate.

Q: My carrier has informed me to use the old codes in place of the new Category III codes 0066T and 0067T to report CT colonography. Should I be concerned about compliance?

A: If you carrier's system is not set up as yet to accept the new category III codes implemented in July 2004 to identify screening (0066T) and diagnostic (0067T) CT colonography studies, ask the carrier to provide something to you in writing stating the appropriate codes to use until their system is updated. As of January 1, 2005, however, all radiology practices and payers will need to have their systems updated to send and receive the appropriate codes on the date the codes become valid, as noted in the Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules. There will no longer be a 90-day grace period. Reference the Mar/Apr 2004 ACR Radiology Coding Source™ for further discussion of this change in policy.

Q: Is it appropriate to report the fluoroscopic guidance and injection codes used when performed in conjunction with a nuclear medicine therapeutic synovectomy?

A: Yes, it is appropriate to report one of the injection codes (20600-20610) and fluoroscopic guidance for needle placement code (76003) when performed in conjunction with intra-articular radiopharmaceutical therapy (79440). The introductory language to the Nuclear Medicine Therapeutic section of the CPT® 2005 book has been updated to note the appropriateness of separately reporting these services. It states “For intra-arterial, intra-cavitary, and intra-articular administrations, also use the appropriate injection and/or procedure codes, as well as imaging guidance and radiological supervision and interpretation codes, when appropriate.