Endocrine System - MedLearn

1 39 2017 MedLearn Publishing, A Division of Panacea Healthcare Solutions, copyright 2016 American Medical Association. All rights reserved. Endocrine SystemCPT Codes: 78012 78099 REVENUE CODES: 340 OR 341 Typical Drugs and Radiopharmaceuticals UsedHCPCSD escriptionNotesRCSIA9500 Technetium tc-99m sestamibi, diagnostic, per study doseCardiolite, Miraluma, Mibi, Sestamibi, Cardiolite343NA9502 Technetium tc-99m tetrofosmin, diagnostic, per study doseMyoview, Tetrofosmin, Tetro343NA9505 Thallium tl-201 thallous chloride, diagnostic, per millicurieThallium 201, Thallium, Thal-lous Chloride USP343NA9509 Iodine i- 123 sodium iodide , diag-nostic, per millicurieUse for 1-4 mCi doses of I-123 for whole body imaging for less than 1 mCi and thyroid imaging see A9516343NA9512 Technetium tc-99m pertechnetate, diagnostic, per millicurieStraight Tech.

2 sodium Pertechnetate, Pertechnetate, Tech, Technetium, Technescan, Technelite343NA9516 Iodine i- 123 sodium iodide , diag-nostic, per 100 microcuries, up to 999 microcuriesDx 1-123 Capsules, I one twenty three, I -123. For ad-ministrations greater than 999 microcuries, see i-131 sodium iodide capsule(s), diagnostic, per millicurieI-131 Dx Caps Per mCi, I One Thirty One, I-131, Iodotope343NA9529 Iodine i-131 sodium iodide solu-tion, diagnostic, per millicurieDx I-131 sol per mCi, I one thirty one, I-131, Iodotope343NA9531 Iodine i-131 sodium iodide , diag-nostic, per microcurie (up to 100 microcuries)Dx I-131 up to 100 Ci, I one thirty one, I-131343NA9582 Iodine i-123 iobenguane, diag-nostic, per study dose, up to 15 millicuriesCommon name: I-123-MIBG.

3 Trade name: AdreView. 343NQ9969 Technetium Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study doseUse with 95 percent non-HEU 99mTc sourced radiopharma-ceuticals343KC9898 Radiolabeled product provided during a hospital inpatient stayEffective Oct. 1, 2008344NJ3240 Injection, thyrotropin alpha, mgThyrogen636 KTypical studies of the thyroid may be uptakes, scans or both. Additional exams of the Endocrine System may include thyroid imaging to detect metastasis, SAMPLE - 2017 EDITION40 2017 MedLearn Publishing, A Division of Panacea Healthcare Solutions, copyright 2016 American Medical Association. All rights imaging and adrenal imaging.

4 Thyroid scans may include a vascular flow study when using technetium pertechnetate (99mTcO4-). Thyroid scans show a picture of the thyroid gland. Thyroid uptakes produce a numerical value only. No image is produced. This calculation determines whether a patient s gland is overactive (hyperthyroid), under- active (hypothyroid), or normal (euthyroid). Parathyroid studies are help-ful when trying to differentiate between solitary adenoma from a generalized parathyroid When procuring the radioactive material, be certain to submit a sepa-rate charge for each radiopharmaceutical utilized. Some payers may ask you to submit an invoice when billing for these items.

5 All parties ( , physicians, hospitals, etc.) will now need to identify the diagnostic radiopharmaceutical(s) with appropriate HCPCS Level II A or C codes. (C-series HCPCS codes are only for Medicare outpatient hospital coding and billing.) H ospital providers may consider reporting HCPCS Level II Q9969 per study dose, with any of the 99mTc based radiopharmaceutical HCPCS codes, only when the hospital can document (see CMS documentation requirements on page 21 of this publication) that the patient received technetium derived from at least a 95 percent non-HEU source. Additionally, if more than one study dose was administered to the patient, it would be appropriate to report multiple units based on the number of study doses, as long as each study dose meets the code description and documentation requirements.

6 (NOTE: At the time of publication, Q9969 may only be reported for Medicare out- patient hospital coding/billing, and we are not aware of any other payers accepting or adopting this policy.) When medically appropriate and covered by payers, the nuclear medicine department may procure and administer Thyrogen (thyrotropin alfa) for patients with a history of differentiated thyroid carcinoma. In these cases, providers would code for the drug with HCPCS level II code J3240 injection, thyrotropin alpha, mg. For the injection of the drug, use CPT code 96372 therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular. If nuclear medicine diagnostic imaging and this injection are performed on the same date of service, a modifier 59 would be required to indicate to the payer that this procedure is separate from the radiopharmaceutical administered for the nuclear medicine imaging SystemSAMPLE - 2017 EDITION41 2017 MedLearn Publishing, A Division of Panacea Healthcare Solutions, copyright 2016 American Medical Association.

7 All rights reserved. 78012 Thyroid Uptake, Single or Multiple Quantitative Measurement(s) (Including Stimulation, Suppression, or Discharge, When Performed)GENERAL DEFINITIONThis service is for performing thyroid uptake(s) only with no imaging. The pa-tient is typically given a radioactive capsule (occasionally solution) to swallow (usually 123 Iodine, or 131 Iodine) and then asked to return for either one or mul-tiple measurements. The time interval may be two hours, four hours, six hours, and/or 24 or more hours after initially swallowing the diagnostic radiopharma-ceutical. A device (uptake probe or gamma camera) is directed at the patient s thyroid gland (in the neck area).

8 Counts are obtained of the patient s neck and a standard for background purposes. All these varying counts are factored into a formula, and the end result is a percentage uptake. This percentage defines whether the patient s thyroid is classified as overactive, underactive, or nor-mal. The key point is that this code is for one or more than one time interval measurement(s) (uptake) only, without any D o not unbundle the uptake and imaging procedure into separate compo-nent codes. If a combined code exists describing the study done, it must be used. In other words, do not charge separately for the thyroid uptake and the thyroid scan, including when performed on different DOS.

9 U se this code if one or more measurements for thyroid uptake are per-formed. U se this code if thyroid stimulation, suppression, or discharge is per-formed; however, these elements are not required to report the service and are not Thyroid Imaging (Including Vascular Flow, When Performed);GENERAL DEFINITIONThis service is for performing thyroid imaging only, no uptake measurement(s). Regardless of the isotope used (99mTcO4, 123 Iodine or 131 Iodine), this code Endocrine SystemSAMPLE - 2017 EDITION42 2017 MedLearn Publishing, A Division of Panacea Healthcare Solutions, copyright 2016 American Medical Association. All rights be used to report the imaging services when performed without mea-surements.

10 The imaging is typically three or more views, anterior, RAO or LAO with or without additional marker imaging to identify palpable nodules. Imaging may be on a single day or over several days. The imaging also can in-clude the initial flow to the thyroid, performed when the radiopharmaceutical is administered via intravenous D o not unbundle the uptake and imaging procedure into separate compo-nent codes. If a combined code exists describing the study done, it must be used. In other words, do not charge separately for the thyroid uptake and the thyroid scan, including when performed on different DOS. U se this code for any imaging technique, over one or more days.