Cardiology Coding Alert

If you've sometimes struggled over whether to report myocardial perfusion imaging (MPI) add-on codes for wall motion and ejection fraction (EF), you aren't alone. As of Jan. 1, you can kiss that problem goodbye, but this simpler coding comes with a big bite out of your reimbursement. Master the details below to be sure denials don't take any more of your hard-earned dollars.

Remember: You should use CPT 2010 codes for services performed on or after Jan. 1, 2010. Reporting inactive codes will cause denials.

The codes: CPT 2010 deletes the myocardial perfusion imaging codes you've been using and replaces them with new codes that are appropriate regardless of whether the study involves wall motion and EF. CPT seems to be "trying to eliminate the use of multiple codes to describe procedures that are normally performed in one session," says Debby Simmons, CPC, with Cumberland Cardiovascular Associates in Maryland.

Old way: CPT 2010 deletes all of the following:

• 78460-78465 -- Myocardial perfusion imaging ...

• +78478 -- Myocardial perfusion study with wall motion, qualitative or quantitative study (List separately in addition to code for primary procedure)

• +78480 -- Myocardial perfusion study with ejection fraction (List separately in addition to code for primary procedure).

New way: For services on or after Jan. 1, 2010, you'll turn to a new set of myocardial perfusion imaging codes:

• 78451 -- Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)

• 78452 -- ... multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

• 78453 -- Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)

• 78454 -- ... multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection.

For 2010 services, as the descriptors indicate, the new codes include attenuation correction (for SPECT), wall motion, EF by first pass or gated technique, and additional quantification if performed. You will not use a separate code to report those services.

Beware: You know +78478 and +78480 are out the door. But there are two more codes you may have previously used that you need to steer clear of. Because 78451- 78454 include ejection fraction by first pass, you should not report this service separately using 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) or 78483 (... multiple studies, at rest and with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification), warns Jim Collins, CCC, certified cardiology coder and president of CardiologyCoder.com in Saratoga Springs, N.Y.

Fee reality: The all-in-one code approach often means a reimbursement cut and this is no exception. If Medicare's 2010 fee schedule remains as-is, you can expect 36 percent less for 78452 in 2010 (10.52 global RVUs) than for the same 2009 service reported with 78465, +78478, and +78480 (16.42 global RVUs).

That means an approximate drop from $592 in 2009 to $379 in 2010, assuming a 36.0666 conversion factor. (The House had voted to stop the expected conversion factor drop, as of publication time. The Senate had yet to vote.)

This is all too similar to 2009's 35 percent reduction for echocardiography services that resulted when 93306 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography) replaced the previously used combination of 93307 (Echocardiography ...), 93320 (Doppler ... spectral...), and 93325 (Doppler ... color flow...), Collins says.

Resource: As of publication time, the 2010 fee schedule is available at http://federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf . Look for the official version in the Federal Register that will be published on Nov. 25.