CQW Panacea-re-brand-rev3

Radiology

For the Week of April 20, 2015

Question:

I received a denial for HCPCS level II codes A9500 and A9512 on the same claim stating invalid combination. Prior to imaging of the neck and upper mediastinum, we gave two separate injections: 2.7 mCi of Tc-99m as pertechnetate and 25.4 mCi of Tc-99m labeled sestamibi. Do you know why this combination can't be charged on the same claim?

Answer:

The edit exists because pertechnetate is a component of sestimibi (and some other radiopharmaceuticals), and payers don’t want you to break out one code (A9512) for the pertechnetate and another for the MIBI (A9500).

However, when two separate injections are given, you can code both and add modifier -59 to A9512. For more directions on this, see the NCCI Policy Manual for Medicare Services, Chapter 9, section E8 at http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.

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