Cardiology Coding Alert

Coding for positron emission tomography (PET) scans depends mainly on whether the scan is a single or multiple test and whether it is conducted while the patient is at rest or under stress, through either exercise or pharmaceutical inducement. Although PET scans may be new to many coders, these nuclear diagnostic tests pose some of the same coding issues as the more commonly used single-photon emission computerized tomography (SPECT) scans.

In general, a PET scan is a noninvasive diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in an organ system, including the circulatory system. During a PET scan, the patient receives a radiopharmaceutical injection - typically rubidium-82 for cardiology imaging - through a previously placed catheter and is scanned in a cyclotron equipped with a gamma camera. Larger cardiology practices use PET scans to measure myocardial blood flow or perfusion and to assess the extent of coronary artery disease (CAD) after inconclusive SPECT scans. At this point, cardiologists routinely use PET scans to assess the viability of heart muscle, says Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle. PET scanning is considered the gold standard for assessing whether that heart muscle is still alive and would recover if you supplied it with more blood, he observes. Bone Up on PET Coding Basics You should use 78459 (Myocardial imaging, positron emission tomography [PET], metabolic evaluation) "to report PET imaging for myocardial viability (metabolic evaluation) only," according to the American College of Cardiology's Guide to CPT 2002. When the cardiologist performs a single study scan, you should report 78491 (Myocardial imaging, positron emission tomography [PET], perfusion; single study at rest or stress). If the physician does multiple studies either at rest or with stress, the procedure should be coded 78492 (... multiple studies at rest and/or stress). Typically, cardiac physicians perform PET scans on patients who have CAD with left ventricular dysfunction, says Melody Mulaik, MSHS, CPC, RCC, a coding specialist with Atlanta-based Coding Strategies Inc. For example, a patient may have ischemic heart disease. Consequently, you would use codes in the 410-414 range to indicate location and intensity of the lack of blood flow to a particular region of the heart.

Usually, the physician records a transmission scan immediately prior to the study to improve the quality of the reconstructed data. You should not bill separately for that, however, because it's considered an inherent part of the PET scan, Mulaik says.

If the cardiologist performs a perfusion evaluation in addition to the metabolic evaluation, you would use 78492, Mulaik says. Choose HCPCS Codes According to Diagnostic Test As of Oct. 1, Medicare will cover myocardial perfusion studies using PET scanning with rubidium-82 on FDA-approved equipment. [...]