Cardiology Coding Alert

The latest National Correct Coding Initiative (NCCI) edits version 9.1, effective in April could bring changes to the way you report myocardial perfusion (SPECT) studies, blood pool imaging (MUGA), and cardiac catheterization. Only eight of 2,738 mutually exclusive additions (which means you cannot report the listed codes at the same session) have any effect on the cardiology coder, says Martha Gerant, CPC, professional coder and reimbursement specialist for Cardiology Services in Olathe, Kan.

Even so, the edits could be especially significant for practices that perform SPECT and MUGAscans, because the comprehensive codes for these procedures now bundle several codes for lesser studies. So you should read the documentation carefully to verify exactly what aspects of these tests the physician performed, Gerant advises. Specifically, comprehensive SPECT code 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification) now includes 78473 (Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress [exercise and/or pharmacologic], with or without additional quantification) and 78483 (Cardiac blood pool imaging, [planar], first pass technique; multiple studies, at rest and with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification). The reason for this bundling is that myocardial perfusion imaging, whether done by SPECT or planar, would include all the MUGAprocedures as well, Gerant says. Both 78473 and 78483 now also include 78461 (Myocardial perfusion imaging; multiple studies [planar], at rest and/or stress [exercise and/or pharmacologic], and redistribution and/or rest injection, with or without quantification) and 78494 (Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing).

Moreover, 78494 now includes 78472 (Cardiac 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) and 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). The edits also indicate that you should not report modifier -59 (Distinct procedural service) with any of the mutually exclusive component codes, such as 78478 and 78480, which are add-on codes for planar and SPECT studies, and 78496, which is an add-on code for blood pool imaging, Gerant says. Several of the MUGA comprehensive codes 78472, 78473, 78481, 78483, 78494 and 78496 are non-mutually exclusive, which means you can sometimes report these together if the procedure is medically necessary, Gerant adds. Coders should pay attention to the use of modifier -59 with the non-mutually exclusive codes, she says. Modifier usage may [...]