November 2005
Get ready for 2006 nuclear medicine coding and payment changes with SNM's reimbursement seminars
Two seminars take mystery out of 2006 HCPCS level II radiopharmaceutical and drug codes
RESTON, Va.--The Society of Nuclear Medicine wants to prepare nuclear medicine professionals for the ins and outs of coding, coverage and payments for procedures and products--especially in light of the more than 60 changes recently made to the 2006 Healthcare Common Procedure Coding System (HCPCS) Level II code set by the Centers for Medicare and Medicaid Services.
"Until practices get used to the new coding scheme, physicians, technologists, coders and others responsible for the proper coding of nuclear medicine procedures may find these changes confusing," said Gary Dillehay, M.D., FACNP, FACR, chair of SNM's Coding and Reimbursement Committee. To sort through the CMS additions, revisions and deletions--which become effective Jan. 1, 2006--SNM is offering two reimbursement seminars to help health care practitioners code correctly and safely, he added. "Nuclear medicine professionals work hard to provide the highest quality patient care; they should use the same care to ensure that coding complies with current policy and that they are properly reimbursed," said Dillehay.
"While the new HCPCS manual includes plenty of changes, the news is virtually all good for the nuclear/molecular imaging community," said SNM's coding adviser Denise A. Merlino, MBA, CNMT, FSNMTS. "CMS has changed the code definitions to make them match the way practices purchase and administer radiopharmaceuticals to their patients," she added. "Practices should immediately begin to update the charge description master or chargemaster, effective January 1, 2006," said Merlino, indicating that the comprehensive and hospital-specific listing of each item that can be billed to a patient, payers or other health care providers will need "a major overhaul."
For example, code A9515 had been defined as "supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99 mm pentetate, per mci," said Merlino. The new code--A9539-- provides for "technetium TC-99m pentetate, diagnostic, per study dose, up to 25 millicuries," she added. CMS has also added codes J2805 (injection, sincalide, 5 micrograms) and J1265 (injection, dopamine, 40 mg).
SNM Reimbursement Roadshow participants learn how to properly code today's nuclear medicine procedures and radiopharmaceuticals; to use current procedural terminology (CPT); to identify nuclear medicine procedures that are covered--or not covered--by Medicare and third-party payers; and to evaluate coding and billing practices in light of the CMS correct coding initiative. Individuals from physician offices, clinics, hospitals, and independent diagnostic and testing facilities will obtain the new and revised 2006 HCPCS Level II radiopharmaceutical and nuclear medicine-related drug codes, ensuring that billing systems are correct and current for 2006. Faculty members Dillehay, Merlino and Kenneth McKusick, M.D., FACNP, concentrate on the interpretation and application of the latest in CPT and Medicare for 2006, including the physician fee schedule (PFS) in an office and hospital, the ambulatory payment classification in a hospital outpatient payment system (HOPPS) and the correct coding initiative.
Reimbursement Roadshows are being held Jan. 28, 2006, at the Westin Casuarina Hotel and Spa in Las Vegas, Nev., and Feb.17, 2006, at the Sheraton Yankee Trader in Ft. Lauderdale, Fla. These seminars are approved for AMA PRA Category 1 credit; VOICE credit is also available. An application will be submitted for American Academy of Professional Coders CEUs. Cost to attend a seminar is $375 for SNM members, $450 for nonmembers. For more information or to register, go online to http://www.snm.org/roadshow.
About the Society of Nuclear Medicine
The Society of Nuclear Medicine is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of nuclear medicine and molecular imaging to diagnose, manage and treat diseases in women, men and children. Founded more than 50 years ago, SNM continues to train physicians, technologists, scientists, physicists, chemists and radiopharmacists in state-of-the-art imaging procedures and advances; provide essential resources for health care practitioners and patients; publish the most prominent peer-reviewed resource in the field of nuclear and molecular imaging: The Journal of Nuclear Medicine; sponsor research grants, fellowships and awards; and host the premier nuclear medicine annual meeting. SNM members have developed--and continue to explore--biological and technological innovations in medicine to look noninvasively into the molecular basis of diseases to benefit countless generations of patients. SNM is based in Reston, Va.; additional information can be found online at http://www.snm.org.