Cardiology Coding Alert

Tip: Always ask, was this done at rest or stress?

Are you confused about which multiple uptake gated acquisition (MUGA) scan or single photon emission computed tomography (SPECT) cardiac blood pool codes to use when? This expert advice will show you how to get your claims in order, without the hassle factor.

Examine the Multiple-Studies Component of 78473

Many coders have difficulty differentiating the following cardiac blood pool imaging scan codes: 78473 (Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress [exercise and/or pharmacologic], with or without additional quantification) and 78494 (Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing).
 
Takeaway tip #1: Rest or Stress - You should always ask, was the test performed when the patient was at rest or stress? The answer will direct you to the correct code.

For example, if your cardiologist performed the blood pool imaging at rest only, then you automatically know that this was a single study. You may report a single study using 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without additional quantitative processing). Notice the "at rest or stress" section in the descriptor, meaning this service only contains one of these elements.

In contrast, multiple studies include both rest and stress, not just one of those elements. Therefore, rest only means single study. Keep in mind though, for the vast majority, you'll see a multiple study (such as, 78473).

A quick and easy way to differentiate 78473 is noting that it contains two procedures and two sets of pictures, says Bart Outzen RT, RT(N), CNMT, director of nuclear medicine at Cardiovascular Physicians PA in Greenville, Miss.
 
For 78473, the technician injects the patient, then he takes images while the heart has a regular rhythm, and then again when the heart is at exercise (stress). Keep in mind that you'll report additional codes (93015-93018 and potentially a pharmaceutical stress agent) for the stress procedure.

Takeaway tip #2: Get That Documentation in Order - If you report a pharmacologic stress agent, you'll need to include the reason for the use of pharmacologic stress in addition to submitting the ICD-9 code that supports the claim. That's also in addition to a copy of the referral order and reason for referral for the test that many carriers also require, says Cynthia A. Swanson, RN, CPC, senior managing consultant for Seim, Johnson, Sestak & Quist LLP, in Omaha, Neb. And don't forget to show compliance with the physician supervision requirements. Check your carrier's policy for more information.

Steer SPECT Coding Toward 78494

MUGA scans aren't the only services that use cardiac blood pool imaging. You'll also find one such code for a single photon emission computed tomography.

Heads-up: When a patient undergoes cardiac blood pool imaging using SPECT, you'll report 78494.

SPECT involves images in slices and is much more detailed than planar imaging. A rotating nuclear medicine camera acquires data in cross-sectional slices to produce three-dimensional views of the heart. Notice how this is a single study performed when the heart is at rest. You can think of this as one procedure with one set of SPECT images, Outzen says.
 
The thing that differentiates a SPECT study (78494) from a planar study (78472) is the last letters of the word SPECT, which stand for computed tomography.

Think of it this way: Computed tomography is the construction of three-dimensional images from one-dimensional slices. A planar study involves the creation and assessment of two-dimensional images. A SPECT study, on the other hand, involves the creation and assessment of three-dimensional images.
 
Don't Forget to Add Stress Codes

If you're reporting a cardiac blood pool imaging procedure that includes stress (78472, 78473, as well as 78481, Cardiac blood pool imaging [planar], first pass technique; single study, at rest or with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification, and 78483, ...multiple studies, at rest and with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification), you'll need to report accompanying codes to reflect that portion of the procedure.

To do so, you should use one of the following four codes: