Cardiology Coding Alert

Question: Why am I getting denials for radiopharmaceutical injection (79101) with MPI (78452)?

Alabama Subscriber

Answer: You should use 79101 (Radiopharmaceutical therapy, by intravenous administration) for IV administration for radiopharmaceutical therapy. You should not use it for a diagnostic test like 78452 (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]; multiple studies, at rest and/or stress [exercise or pharmacologic] and/or redistribution and/or rest reinjection).

Also note that 78452 is a Column 2 code for 79101, according to the Correct Coding Initiative (CCI) edits, so the two codes are bundled. There is a modifier indicator of 0, so you cannot override the edit under any circumstances.