Many a time, Correct Coding Initiative (CCI) compliance requires looking beyond the edit pairs CCI edits do not bundle SPECT (78803) and planar (78070) parathyroid imaging codes, however coding experts often tell you not to code the two together for SPECT and planar parathyroid imaging on the same date.

You need to add some method to this madness by taking a look at the information offered by coding resources, the Society of Nuclear Medicine (SNM) as well as the NCCI Policy Manual for Medicare Services (CCI Manual).

1. Society of Nuclear Medicine singles out 78803

SNM's online Practice Management Coding Corner features a Q&A that recommends reporting 78070 (Parathyroid imaging) for planar imaging alone, however 78803 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; tomographic) for parathyroid SPECT imaging with or without planar, according to Jackie Miller, RHIA, CCS-P, CPC, VP of product development for Coding Metrix Inc. in Powder Springs, Ga.

Support: select the single code that describes the protocol and procedure carried out," according to the Q&A, located at http://interactive.snm.org/index.cfm?PageID=2442&RPID=1995. SNM "would NOT recommend coding both CPT codes," according to the article.

2. Correct Coding Initiative makes the case for SPECT code

Although there is not, you won't find any specific edit bundling 78070 and 78803, CCI does address the SPECT/planar issue in the CCI manual, according to Miller.

CCI Manual, Chapter 9, Section E.2, says that you may not report a SPECT study and planar study of the same limited area as "single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. When a limited anatomic area is studied, there's no additional information that can be got by obtaining both planar and SPECT studies."

Bonus tip: According to the manual, you may report both planar and SPECT codes only when the size of the scanned area makes both sets necessary like whole body bone scans with SPECT studies, according to nuclear medicine coding expert Denise Merlino, MBA, CNMT, FSNMTS, CPC, president of Merlino Healthcare Consulting in Magnolia, Mass. What's more, keep an eye out for vascular flow studies. If the radiologist carries out planar vascular flow studies alongside SPECT studies, you should report the vascular flow combined code, not the flow, planar and SPECT studies independently, says Merlino.