Cardiology Coding Alert

Plus: A simple trick for identifying and coding first pass studies

If you're having a tough time figuring out what code to use for myocardial perfusion imaging studies, multi-gated acquisition scans (MUGA), and first past techniques, you're not alone. Learn the following in's and out's of these often frustratingly similar codes and take note of the National Correct Coding Initiative's most recent edit to streamline your claims every time. Master Myocardial Perfusion Studies Myocardial studies are usually single-photon emission computed tomography (SPECT) studies (such as 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).

A SPECT study involves a technician injecting a radiopharmaceutical imaging agent into the patient's vein. The agent used (typically Myoview, Thallium or Cardiolite) becomes trapped in the muscle of the heart. The radiopharmaceutical then emits radiation out through the patient's chest. Finally, a special camera visualizes these emissions to provide the doctor with an image of how blood is flowing to the patient's heart muscle.

A SPECT study checks to see how the coronary arteries are supplying blood to the left ventricular myocardium - the left ventricular muscle, says Bart Outzen, RT, RT(N), CNMT, director of nuclear medicine at Cardiovascular Physicians PA in Greenville, Miss., "so you're looking for ischemia." Equate MUGA with ERNA In contrast to a SPECT study, "for a MUGA scan the cardiologist is looking at the blood pool to study the function of the left ventricle and not looking for ischemia," Outzen says.
 
With MUGA studies (such as 78494, Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing), some of the patient's blood is first withdrawn by venipuncture and then infused with a special radiopharmaceutical imaging agent.

During MUGA studies (such as A9512, Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m pertechnetate, per mci), physicians use agents that are different from those used for myocardial perfusion imaging in that they do not become absorbed by the patient's heart muscle. These agents stay in the patient's blood stream.

The radiopharmaceutical-infused blood cells circulate through the patient's vascular system several times. After several trips through the circulatory system, the agent reaches a state of "equilibrium" with the patient's blood. At this point, the technician performs the imaging. Because the radiopharmaceutical commingles with the patient's natural blood for so long, it is heavily diluted. This dilution requires the capture and averaging of data from several images over several cardiac cycles.

Keep in mind: The technical term for MUGA studies is actually ERNA or equilibrium radionuclide angiocardiography, Outzen says. Cardiologists use ERNA to determine the following information:
  left ventricular [...]