CPT code 78072 is for a parathyroid scan using SPECT and CT imaging to assess parathyroid gland function and detect abnormalities.
CPT code 78072 is used to describe a medical procedure that involves a parathyroid planar imaging study with the addition of SPECT (Single Photon Emission Computed Tomography) and CT (Computed Tomography). This procedure is typically performed to evaluate the parathyroid glands, which are small glands located near the thyroid that help regulate calcium levels in the body. The combination of SPECT and CT provides detailed images that help healthcare providers assess the function and structure of the parathyroid glands, aiding in the diagnosis and management of conditions such as hyperparathyroidism or parathyroid tumors.
When considering whether CPT codes 78071 and 78072 require any modifiers, it's important to understand the context in which these codes are used and the specific circumstances of the procedure. Below is a list of potential modifiers that could be applicable to these codes, along with the reasons for their use:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the imaging study, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and the performance of the imaging study, excluding the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be necessary if the imaging study is performed in conjunction with another procedure that is not typically reported together. It indicates that the service is distinct and separate from other services provided on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: If the same imaging study needs to be repeated on the same day by the same physician, this modifier is used to indicate that the repeat procedure was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same imaging study is repeated on the same day by a different physician. It helps to clarify that the repeat procedure was necessary and performed by another provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can sometimes be applicable if the imaging study is repeated for clinical reasons and not due to equipment malfunction or error.
7. Modifier 99 - Multiple Modifiers: If more than one modifier is applicable to the procedure, this modifier is used to indicate that multiple modifiers are being applied to the service.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the service provided. It's crucial to review payer-specific guidelines and documentation requirements to determine the necessity and appropriateness of each modifier for the specific scenario.
CPT code 78072 is subject to reimbursement considerations under Medicare, which involves several factors including the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis.
Whether CPT code 78072 is reimbursed by Medicare can depend on its inclusion in the MPFS and the specific guidelines set forth by the MAC that administers Medicare claims in your area.
Each MAC may have different coverage determinations, so it is crucial to verify with your local MAC to ensure compliance with their specific reimbursement policies for CPT code 78072.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 78072. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
