Cardiology Coding Alert

You must have this documentation to report 78478, 78480Are you reporting all the nuclear medicine services your cardiologist is performing? If not, you could be jeopardizing the extra revenue your practice needs.Read through this nuclear medicine note, and determine all the codes you should report. Then compare them with our experts' recommendations.First, Read the NoteImpression: Normal examination.Clinical indication: Chest pain.Test: The patient exercised for 8 minutes 52 seconds and reached a maximum heart rate of 152 beats per minute or 86 percent of the maximum predicted for age. I gave the patient 30 millicuries of technetium-99m-labeled sestamibi at peak heart rate. I obtained tomographic images of the heart 30 minutes later. I performed a gated study, and I calculated the left ejection fraction. I generated the report after I reviewed both the attenuation and the non-attenuation corrected images.ResultsSPECT perfusion: There is uniform tracer distribution throughout the left ventricle and no focal abnormality.Gated images: Left ventricular cavity size is normal. There is normal regional wall motion and thickening.LVEF: Left ventricular ejection fraction is calculated to measure approximately 65 percent.Focus on Nuclear CodesAccording to Tammy Judd, hospital coordinator at Spokane Cardiology in Washington, when you read the test notes, you should have isolated the following key phrases:• "I obtained tomographic images of the heart 30 minutes later." This tells you the SPECT code.• "I performed a gated study." This tells you the left ventricle (LV) code.• "I calculated the ejection fraction." This tells you the ejection fraction (EF) code.SPECT: First, you should report the myocardial perfusion imaging code 78464 (Myocardial perfusion imaging; tomographic [SPECT], single study [including attenuation correction when performed], at rest or stress [exercise and/or pharmacologic], with or without quantification) for "single study."LV: You should report +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) because the cardiologist evaluated the function of the left ventricle. Code 78478 represents the actual assessment of watching the ventricle contract and relax.EF: The cardiologist also evaluated ejection fraction, which is the number that's generated from the wall motion study. For this service, you should report +78480 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]).Red flag: You cannot bill 78478 unless the physician assesses the wall motion, nor can you bill 78480 unless the doctor assesses the ejection fraction, says Cheryl Klarkowski, RHIT, coding specialist with Baycare Health Systems in Green Bay, Wis. Make certain your cardiologist's documentation includes these evaluations.Remember, if your cardiologist performs these three radiologic services in the hospital, you should append modifier 26 (Professional component) to each code (78464, 78478 and 78480), Judd says.Determine the Stress Test CodeStress test: For the stress test [...]