CPT code 78990 is used for diagnostic procedures involving the administration of radionuclides to evaluate organ function or structure.
CPT code 78990 is used to describe the provision of diagnostic radionuclides. In simpler terms, this code is applied when a healthcare provider supplies radioactive substances that are used in diagnostic imaging procedures. These radionuclides are essential for certain types of scans, such as PET or SPECT scans, where they help create detailed images of organs and tissues to aid in diagnosis. This code specifically covers the supply of these substances, not the imaging procedure itself.
When considering the use of modifiers for the CPT codes provided, it's essential to understand the context of the services rendered and the specific circumstances that might necessitate a modifier. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It is applicable if the physician is providing only the interpretation of the nuclear medicine data or diagnostic radionuclide service.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It applies if the facility is billing for the use of equipment, supplies, and technical staff involved in the procedure.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple procedures are performed and need to be billed separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier might be applicable if the nuclear medicine data processing or diagnostic radionuclide service is repeated for clinical reasons.
7. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required.
Each modifier serves a specific purpose and should be used in accordance with the guidelines set forth by the payer and the specific circumstances of the service provided. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
CPT code 78990 is subject to reimbursement considerations under Medicare, but whether it is reimbursed can depend on several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) in your region.
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services, and it is updated annually.
Each MAC, which administers Medicare benefits in different regions, may have specific guidelines or local coverage determinations that affect the reimbursement of certain CPT codes, including 78990.
Therefore, to determine if CPT code 78990 is reimbursed by Medicare, it is essential to consult the latest MPFS and check with your regional MAC for any specific coverage policies or requirements.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including specific codes like 78990, and by individual payer. Schedule a demo today to see how RevFind can optimize your financial outcomes 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
