Nuc Med procedure without radiopharm

Hi Sarah, I received the following question and responded with the information regarding C9898 (RP provided to inpatient with subsequent outpatient procedure), but don't know what they should do for an outpatient. They confirm that they are truly doing 78018 (Thyroid whole body scan). Any thoughts? TIA.


"Can you advise us on how we should bill Medicare for the following scenario.

Patient comes in for approx. three days in a row for a series of test for cpt code 79005 with Radio pharmaceuticals I131, A9517 etc:
Pt returns one week later for follow up visit - procedure code cpt 78018 without pharmaceuticals.
Medicare is rejecting the return visit - for missing Radio pharmaceuticals?
Nuclear Medicine said no drugs are used for the follow-up scan.

How do we handle this?"

My non-biller answer...

The thyroid scan involves injecting radioactive iodine then scanning the body to see if there is uptake. Like many nuclear procedures there are multiple scans over several days. It is still considered one test. The procedure should be billed on the first day with the test and the nuclear agent; you would not bill each day separately. Use modifier 52 or 53 if you do not complete test.