Conquer Your Nuclear Medicine Claims by Mastering This Op Report
Published on Thu Feb 22, 2007
Hint: One code will depend on the setting Prepare for complicated nuclear medicine claims by challenging yourself with this example. Read the report and then decide what codes you would submit before you go any further. Then, check your answers against our experts'. First, Read This Report
Clinical indication: Chest pain
Test: Rest/direct pharmacologic vasodilation
Radiopharmaceutical and dose: Tc-99m labeled sestamibi; 10 mCi at rest and 40 mCi following adenosine infusion
Technique: Single-day protocol; acquired a study at rest first; two hours later, the patient received a standardized five-minute adenosine infusion. The patient also received the radiopharmaceutical two minutes within the infusion.
Acquisition: Thirty minutes following the administration of radiopharmaceutical; SPECT perfusion images, gated wall images at rest and following adenosine infusion. Computer-generated left ventricular ejection fraction calculation. The provider reviewed the report generated after both the attenuation and nonattenuated corrected images. RESULTS
SPECT perfusion: There is a small-to-moderate-size severe reduction of photon intensity within the basal inferior septal wall. The images acquired at rest show partial, though significant, improvement of photon intensity at this location.
Gated images: Left ventricle cavity size is moderately dilated. There is moderate-to-severe septal and inferior septal wall hypokinesis with mild hypokinesis elsewhere within left ventricle.
LVEF: The left ventricular ejection fraction is calculated to be approximately 30 percent.
Impression: Dilated cardiomyopathy with reduced left ventricle ejection fraction measured to be 30 percent. Small-to-moderate-size, severely decreased intensity, partially though significantly reversible basal inferior septal wall defect.
Now decide how you would code this report.
See How Your CPT Codes Compare SPECT: First, you should report the myocardial perfusion imaging code 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification) for "multiple studies," says Cheryl Klarkowski, RHIT, coding specialist with Baycare Health Systems in Green Bay, Wis. Keep in mind: This code accurately represents both one- and two-day testing protocols.
Left ventricle: 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 motion of the left ventricle. Code 78478 represents the actual assessment of watching the ventricle contract and relax.
Ejection fraction: 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]).
Key: You cannot bill 78478 unless the physician assesses the wall motion, nor can you bill 78480 unless the doctor assesses the ejection fraction, Klarkowski says. You may tend to report these codes a lot -- "My physician usually does 78478 and 78480 with the multiple studies SPECT code (78465)," she adds -- but make certain your cardiologist's [...]
