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Cardiology Coding Alert

Get a Grip on First-Pass Studies

Published on Sun Aug 31, 2003

Here's what you'll need to know to bill 78496
 
You're clear on myocardial perfusion add-on billing but a little fuzzy on reporting first-pass techniques with cardiac blood pool imaging (MUGA, multiple gated acquisition) studies. Right? If so, here are some first-pass basics from coding experts that will help you report these procedures accurately.
 
First, you should know that the difference between a myocardial perfusion study and a gated blood pool imaging is that the myocardial perfusion measures how the myocardium is supplied with blood and illuminates ventricular function while a MUGA measures the volume of blood inside the ventricle. Report 78472 (Cardiac blood pool imaging, gated equilibrium ...) and add +78496 (... single study, at rest, with right ventricular ejection fraction by first-pass technique ...) when the physician performs a first-pass study with the MUGA.
 
During a first-pass study, which typically takes place as the MUGA scan's initial phase, a nuclear camera timed to the cardiac cycle records in a quick succession images of an injected isotope's first passage through the right ventricle, says Ron Bar-Haim, CNMT, with Athens Cardiology Group in Athens, Ga.
 
The first-pass technique provides both quantitative and qualitative assessment of the heart. In addition to ejection fraction of the right and left ventricles, physicians can assess wall motion and ventricular volumes, Bar-Haim says. If your practice is using first-pass studies, you'll need to know what should be in the report.
 
Check your Medicare carrier's local medical review policy (LMRP) for first-pass coding and documentation guidelines, says Cynthia Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist in Omaha, Neb.

For example, National Heritage Insurance Company's cardiovascular nuclear medicine guidelines state that when you submit 78472 and 78496, you should not report 78478 and 78480, the add-on codes for wall motion and ejection fraction, with perfusion studies (78460-78465), Swanson says. Look for documentation that the nuclear technician performed "simultaneous cardiac function studies using the first-pass technique and that the laboratories are equipped to perform such studies," she says.

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