Question:

We are getting a national correct coding initiative (CCI) edit when we charge 78582—pulmonary ventilation (e.g., aerosol or gas) and perfusion imaging–with A9539 and A9540 for the procedure and radiopharmaceuticals used. Do you have any insights into why this might be occurring? 

Answer:

Because many hospitals were using the wrong radiopharmaceutical HCPCS codes when they billed nuclear medicine studies, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the Centers for Medicare & Medicaid Services (CMS) worked together to develop edits for radiopharmaceuticals that are not normally used with a particular test. 

Looking at your codes, A9539 (technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries) is incorrect for the aerosol DTPA; you should assign A9567 (technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries). There are no edits with this combination (78582 and A9567).

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