Cardiology Coding Alert

Reader Question:

Check Viability Scanning

Published on Wed Jan 01, 2003

Question: What is a viability scan and how should I code it? One of our physicians performed a left heart catheterization, which revealed quite a bit of stenosis. He states in his documentation that due to these findings, the patient underwent a viability scan to assess the viability of his anterior wall to determine whether he should undergo a percutaneous transluminal coronary angioplasty (PTCA).

Kansas Subscriber

Answer: Positron emission tomography (PET) is a noninvasive diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in various organ systems. The cardiologist uses a positron camera (tomography) to produce cross-sectional tomographic images, which are obtained from positron-emitting radioactive tracer substances (radiopharmaceuticals) such as 2-[F-18] Fluoro-D-Glucose (FDG), that the physician administers intravenously to the patient.

Myocardial viability scanning can provide the doctor with information that is not available from other imaging studies. The myocardial scan shows blood perfusion to the heart, and the heart muscle using or metabolizing glucose that the cardiologist injects into the vein. The scan information can help the physician diagnose and manage the disease.

The cardiac physician initially obtains a blood glucose level for all patients to determine the proper protocol to follow the study. The scanner detects the radiation given off from the injected radioactive materials and takes pictures of its distribution in the body. Most commonly, a patient receives a first injection of radioactive ammonia to view the blood supply to the heart. The cardiac physician gives a second injection of a radioactive glucose, which he or she uses to look at glucose metabolism to the heart muscle.

Medicare has issued specific coverage criteria and applicable HCPCS codes for PET imaging services. Refer to the definition of HCPCS code G0230 (PET imaging; metabolic assessment for myocardial viability following inconclusive SPECT study; full- and partial-ring PET scanners only) for myocardial viability PET scan and CPT code 78459 (Myocardial imaging, positron emission tomography [PET], metabolic evaluation) for heart muscle imaging (PET).

Many Medicare carriers have issued information through their provider bulletins/newsletters and/or Web sites specific to PET scans for myocardial viability, coverage provisions and coding/billing guidelines. Check with your local Medicare carrier to determine its guidelines. Providers should also reference Medicare Coverage Issues Manual Sections 50-36 and 50-56 and Medicare Carriers Manual Section 4173.