CODING CORNER: Beef Up Your Nuclear Cardiology Coding

3 expert answers to your top questions on noninvasive heart tests

Nailing nuclear cardiology coding requires a thorough knowledge of common procedures in the field, such as SPECT tests, wall motion studies, and ejection fraction studies. Check out the answers to these frequently asked questions about reporting nuclear cardiology, and you’ll be sending in picture-perfect claims in no time.

1. What is SPECT and how  should I report it?
SPECT stands for single photon emission-computed tomography, which is a procedure in which a camera takes pictures of different slices of the heart so the physician can get a three-dimensional view of it.

You may need to report single or multiple studies of the tomographic SPECT, says Jim Collins, CPC, CHCC, chief executive officer of The Cardiology Coalition in Matthews, N.C. Typically, doctors want to have images of the patient’s heart both at rest and under stress, Collins says. These images help physicians differentiate any perfusion defects to see whether the defects are related to scar tissue or ischemia.
You’ll report SPECT tests with 78464 (Myocardial perfusion imaging; tomographic [SPECT], single study [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic], with or without quantification) or 78465 (... tomographic [SPECT], multiple studies [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification).
2. Can I report ejection fraction with a SPECT study?
Yes, you can, when the physician performs and documents them, says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn. If the physician completed and documented a wall motion study, he may separately bill that as well, she says. A physician order is also needed for these add-on studies.
Note: Be prepared, though, that some payers may not reimburse for either of these studies when the physician performs them with a SPECT exam. You may need to appeal to get paid.
You may use add-on codes +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) and +78480 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]) when the physician performs, interprets, and documents additional studies beyond the standard perfusion imaging code (such as SPECT code 78465).
For example, the wall motion code (78478) represents the actual assessment of watching the heart beat. The ejection fraction (78480) is the number that’s generated from the wall motion study.
 
3. How can I get payers to reimburse for these additional studies?
Your first and most powerful tool is top-notch documentation of wall motion and ejection fraction [...]

- Published on 2006-01-01