Cardiology Coding Alert

Question: Under CMS billing and compliance rules how many times a year can a provider physician office bill 78452 or 78451?

Codify Member

Answer: You should check the individual payer policy. For instance, Cahaba (LCD L30634) states: "Repetitive frequent MPI greater than one per year is not reasonable and necessary unless supported by narrative in the medical record."

Many other policies for myocardial perfusion imaging aren't as specific, simply indicating that the frequency shouldn't exceed the patient's medical needs.

The codes involved are:

• 78451, Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
• 78452, ... multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection.