CMS Corrects Two Coding Errors

June 1, 2004

CMS Corrects Two Coding Errors

In response to communications from the SNM, CMS is correcting two errors related to new CPT code 78804, Radiopharmaceutical localization of tumor or distribution of radiopharmaceuticals agent(s) whole body, requiring two or more days imaging.

Originally, the relative value units for code 78804, which is for two or more days of imaging, was set lower than the rate for 78802,which covers a single whole body study. SNM notified CMS (see Related Links below), and CMS has confirmed that this is an error and that a correction notice will be out soon. The correction will be implemented in the next physician fee schedule update in July 1, 2004, and we are hopeful that the correction will be retroactive to January 1 so that providers can submit claims to recoup the difference.

A related error resulted from a CCI (Correct Coding Initiative) edit that was “fast-tracked” (professional societies did not have an opportunity to comment prior to implementation of the change) by CMS. Currently it is acceptable practice to perform, code, and bill for a tumor whole body and tumor SPECT on the same day. The CCI edit disallowed the billing of CPT codes 78804 and 78803 (multi-day tumor imaging and SPECT) on the same day. SNM again notified CMS. The edit will be eliminated in July, retroactively effective to January 1.

4/12/2004 Letter to National Correct Coding Initiative

4/14/2004 CMS CCI Response with Correction

5/07/2004 Transmittal 173 - New global national payment rate for 78804 is correcte