Radiologist controls MRI or CT or PET Scan with female patient undergoing procedure

We are bracing for a storm of change. It’s not breaking news that we are seeing an overhaul of the code set for cardiac PET procedures in 2020. However, that’s not the end of the changes for nuclear medicine departments this year – there’s also an overhaul for SPECT and SPECT-CT. These changes have been in the works for years, and the result was the deletion of many of the site-specific SPECT codes in favor of more generic codes for planar, SPECT or SPECT-CT radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s).

What’s Changing and What’s the Impact?

As mentioned above, many of the current site-specific SPECT codes are being deleted this year – in total 9 codes in this area are being deleted. In place of the site-specific codes, we are getting 4 new codes (78830, 78831, 78832 and add-on code 78835) plus heavy description revisions for 5 codes (78800-78804).

What does this mean for providers? Instead of selecting a SPECT code based on the anatomic site being imaged, they will now need to choose from one of the more generic codes based on:

  1. The number of areas being imaged
  2. The number of days the imaging is taking place over (i.e., single day or 2 or more days)
  3. Whether or not CT scans were concurrently acquired

The challenge facing nuclear medicine departments in the new year is the fact that many of the codes we are accustomed to using will be gone, and the new options aren’t necessarily a direct crosswalk from the way these procedures were previously coded for years. Take a bone SPECT for example, previously this exam would have been reported with CPT® code 78320. Next year, there will not be a code for bone SPECT. Instead, we will need to choose from the generic codes 78803, 78830, 78831 or 78832 based on the 3 criteria listed above.

It’s easy to see why this could be problematic, and why it’s crucial to fully understand the new codes, what they include and what the documentation requirements are going to be for reporting each.

What’s Not Changing?

During a year of significant changes, it is somewhat comforting to know that a few things are staying the same. As the SPECT and SPECT-CT codes were being re-vamped, there are a couple that are not impacted by the change: myocardial perfusion and parathyroid imaging have retained their site-specific SPECT codes. Continue to report these as usual.

Be Prepared

Now more than ever, it’s important to be fully informed headed into the new year. With the whirlwind of changes coming, working with outdated or incomplete information is not worth the risk. Keep an eye on the latest news coming out of the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), specialty societies and other sources as we learn more about the guidelines and requirements for this new code set.

Two Easy Ways to Stay Informed

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Pre-order the 2020 edition of the Nuclear Medicine & PET Coder. This resource was designed to specifically respond to real-world coding, documentation and billing issues faced in nuclear medicine with workable solutions, distilled into clear-cut instruction, tips, and case examples. Of course, detailed breakdowns of the coming changes will be included in the updated edition with guidance and actionable tips for proper application.

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