Cardiology Coding Alert

Question: During a nuclear scan, a patient received 3.0 mci of thallium, and images were taken. Four hours later, the patient received 1.0 mci of thallium, and delayed images were taken. The next day, the patient had 1.0 mci of thallium injected, and images were taken. Which codes should I use?

California Subscriber
 
Answer: Review the cardiovascular nuclear studies codes (78414-78499) in CPT's cardiovascular system sub-section of the radiology chapter. Most likely, for the service the physician provided on day one, you should report 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). But check the report documentation and ask the physician to confirm that this is accurate.
 
The service on day two was probably a repeat study because of a problem with the first study, such as a technical inadequacy or poor images. Because the physician performed only one study on the second day, you should report the single-study code (78464, ... tomographic [SPECT], single study at rest or stress ...).
You would not need to append modifier -76 (Repeat procedure by same physician) to 78464 because the service was provided on a separate day.