Cardiology Coding Alert

When multi-uptake gated acquisition (MUGA) scans are performed to measure various aspects of the hearts wall motion, coders may be confused not only by the different codes associated with the test, but also by the other procedures often performed at the same time as the scans. To optimize ethical reimbursement, they need to ensure that all the codes applicable to the test, and not just the test itself, have been billed.

These scans, which often are performed in conjunction with a single-photon emission computed tomography (SPECT) scan, measure the motion of the ventricular walls to help cardiologists determine if there is any damage there, says Ray Cathey, PA, MHA, an independent coding specialist in Stockton, Calif. The images are then fed into a computer to measure the actual heart wall movement. MUGAs also determine the ventricle walls ejection fraction, i.e., how much of the blood in the heart gets pumped, in percentage terms. The higher the number, the better the heart is working.

CPT lists six codes that may apply to the two types of MUGA scans:

78472cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing

78473multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification

78481cardiac 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

78483multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study ejection fraction, with or without quantification

78494cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing

78496cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (list separately in addition to code for primary procedure)

Choosing among these codes, which can be confusing in itself, is only one part of the process. Because MUGA tests typically are not performed on their own but are done on patients in a variety of situations, other procedures also may be performed and should be billed in conjunction with the MUGA scan.

Understanding Gated Acquisition Tests

During these tests, which also may be referred to as wall motion studies or radionuclide ventriculograms, the patient receives an intravenous injection of an isotope that tags red blood cells, which allows multiple images of the heart to be synchronized to an electrocardiogram (ECG) (i.e., ECG-gated). The images are then entered into a computer, which provides cine display of cardiac chamber wall motion and calculates ventricular ejection fractions.

Coding will [...]