Ask Dr. Z

Patient with liver cancer. Surgical report states visceral and hepatic angiography with radioembolization using Y90 SIR spheres. They billed 37243 and 79445. Then following this Y90 treatment, they billed 78201 for static liver imaging and 78830 for SPECT, and they document as follows: "Post-procedure bremsstrahlung planar and SPECT acquired. PLANAR - radiotracer is seen through RT hepatic lobe. No significant extrahepatic radiotracer identified. SPECT - radiotracer is seen through RT hepatic lobe. No significant extrahepatic radiotracer identified."  My question is, should they really be billing for a bremsstrahlung since it seems just to be confirmatory, not diagnostic, OR should they report the 78800, which does look at the distribution of the agent? I always thought they should NOT bill for 78830 post Y90 therapy when not diagnostic in nature.