| F-18 Fluoride PET Bone Imaging |
| Revised: February 9, 2009 |
| Question |
| We have been asked to perform whole-body PET bone scans for some of our oncology patients using F-18 fluoride. What codes should we use: 78306, 78320 or both with a modifier 59. Also, is A4641 the proper code to bill for the F-18 fluoride? |
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| Answer |
Effective January 1, 2008 the AMA CPT PET and PET/CT codes changed by removing the word "tumor" to allow a broader use that would include Positron Emission Tomography (PET) bone imaging using F-18 fluoride. Therefore, for third-party payers, choose one of CPT 78811-78816 as these would be most appropriate for dates of service on or after January 1, 2008, if the payer considers PET bone imaging a covered procedure. For Medicare patients see the coding details below as Medicare does not currently cover PET bone scan imaging.
The commonly performed conventional bone scans, CPT 78306 Bone and/or joint imaging; whole-body or CPT 78320 Bone and/or joint imaging; tomographic (SPECT), performed with a Tc-99m phosphonate compound, are now well-entrenched in today's medical terminology and is understood by payers to indicate a specific examination performed with a gamma camera and would NOT be appropriate coding for a PET imaging study.
A bone scan performed using a PET radiopharmaceutical, however, is a specialized examination (likely performed for suspected infection or metastatic disease) that consumes a different level of resources (e.g., PET scanner) and likely would have different relative value and classification (RVU)/ambulatory payment classification (APC) as well as, Practice Expense (PE) value; therefore, prior to January 1, 2008 the unlisted codes are the most appropriate codes to use, on or after January 1, 2008 use one of the PET or PET/CT codes for third party payers. To report the radiopharmaceutical supply prior to January 1, 2009, submit A4641 Radiopharmaceutical, diagnostic, not otherwise classified to identify and bill the F-18 fluoride administered. For dates of service on or after January 1, 2009 providers should report A9580 Sodium Fluoride F-18, diagnostic, per study dose, up to 30 millicuries.
For Medicare patients, providers must use HCPCS Level II code G0235 PET imaging, any site, not otherwise specified. The Medicare National Coverage Determination policy for PET is considered an exclusionary policy. This means that any indication not listed in the policy is considered non-covered. Therefore, PET bone imaging is considered non-covered by Medicare, and providers are instructed by Medicare to use HCPCS Level II G codes for non-covered services for Medicare patients. |
| Disclaimer
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| The opinions referenced are those of the members of the SNM Coding and Reimbursement Committee and their consultants based on their coding experience. They are based on the commonly used codes in Nuclear Medicine, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The SNM and its representatives disclaim any liability arising from the use of these opinions.
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