November 28, 2012
The 2013 Current Procedural Terminology (CPT) electronic file was released by the American Medical Association (AMA) on August 31, 2012. New, deleted and revised codes will be effective on January 1, 2013. Important changes were made to the endocrinology section of nuclear medicine services with minor changes to the nuclear medicine introductory language. The new and deleted codes are listed in the table below.
The new uptake and/or thyroid imaging codes are the result of action taken by the AMA relativity assessment workgroup (RAW) and the Centers for Medicare and Medicaid Services (CMS), which works to identify potentially misvalued codes and services. They identified CPT 78007 Thyroid imaging, with uptake; multiple determinations, as requiring a review by the societies as the service fell into the screen of services that were performed greater than 30,000 times a year and had not been AMA RUC reviewed and with Harvard derived times. In response to this requested review, two code change proposals (CCP) were submitted jointly by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the American College of Nuclear Medicine (ACNM), the American College of Radiology (ACR), the American Association of Clinical Endocrinologists (AACE) and The Endocrine Society (TES) to the CPT editorial panel. The multispecialty society team collaborated over a year and developed one application with three new simplified codes that describe the entirety of these thyroid uptake and imaging procedures. Providers will continue to bill separately for any drug and radiopharmaceutical supply codes administered with these procedures.
New CPT 78012 would be used for performing thyroid uptakes only. Specifically it may be used if you did a single uptake or if you performed multiple uptakes such as at 4 – 6 hour and 24 or 48 hour time intervals. New CPT 78013 would be used for performing thyroid imaging only. It would also include vascular flow if that technique was performed, though vascular flow is not a required element of the new code. Finally, new CPT 78014 is used when you perform a thyroid imaging study plus a single or multiple uptake procedure on the same date of service. We call your attention to words in the code description which are important in selecting the proper code by bolding and underlining key words or phrases in the table below. If vascular flow, or stimulation, suppression or discharge are not performed, CPT still allows use of the new codes and hence the language “when performed” this is similar to the MPI codes, when wall motion or ejection fraction is not performed.
As the endocrine section was under review, several of the societies also recognized the repeated questions and confusion for billing parathyroid studies. We took this opportunity to review the current coding opinions and after review the SNMMI, ACNM and ACR jointly submitted a CCP to modify the current parathyroid code and create two new bundled/packaged parathyroid codes. The revised CPT code 78070 makes clear that this code represents the service utilizing the planar technique and may include subtraction, however subtraction is not a required element of the CPT code. New CPT code 78071 is used to report the planar plus a SPECT study of the parathyroid gland. Finally, new CPT 78072 is used to report the planar plus a SPECT/CT study of the parathyroid gland. Similar to PET/CT codes, the SPECT/CT code is for when the CT is used for attenuation correction only and not for a fully diagnostic CT procedure. If a fully diagnostic CT is separately ordered and medically necessary those services would be reported with the appropriate CT procedure code located in the Radiology section of CPT.
The final change made to the nuclear medicine section of the AMA CPT book is with the introductory paragraphs. These changes are minor and consistent with many other changes in the CPT book this year to eliminate the word “physician” to make clear that other qualified individuals who are licensed would be able to report the services with these codes.
For more information, consult your AMA CPT manual or contact the SNMMI HPRA staff at firstname.lastname@example.org.
The opinions referenced are those of the members of the SNMMI 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 SNMMI and its representatives disclaim any liability arising from the use of these opinions.