READER QUESTIONS: Ejection Fraction Appeal Worth Your Time

Question: Due to recent advances in technology, we are receiving rejected claims from non-Medicare payers when we bill ejection fraction and wall motion codes together. Is there a solid way to appeal these denials, or is there an add-on code we should report? The physician has documented everything.


Missouri Subscriber

Answer: This is a situation in which you need to pick your battles and decide whether appealing these denials is worth your time and effort. If you take the time to educate the payer, you have a legitimate chance of receiving the payment you have earned. Payers deny the wall motion code (+78478, Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) and ejection fraction code (+78480, Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure])- either one or both of them - because they believe the services these codes represent are included in code 78465 (Myocardial perfusion imaging; 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).

You need to get your doctors involved in the appeal and education of the payers. In your appeal, the physician should tell the payer that ejection fraction and wall motion studies are not components of 78465, but additional studies that both require additional interpretation time and result in different diagnostic data. Include clinical paperwork that supports this information: For starters, CPT establishes them as separate services.

- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.