Cardiology Coding Alert

Question: Our cardiologist frequently performs SPECT scans in conjunction with stress tests. Sometimes, the patient is instructed to return the following day. Should we use 78465 twice?

New York Subscriber

Answer: The appropriate code is 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), which describes multiple studies performed at rest and with stress, reported once to cover both days, says Denise Reckers, CPC, a practice coder with Cardiology Consultants, a 13-physician practice in Abilene, Texas.

Coding 78465 once is correct even though the tests were performed on consecutive days. According to the American College of Cardiologys Guide to CPT Coding, this procedure is performed with a treadmill stress test (coded separately using 93015 or 93016 and 93018 as appropriate; see story this issue). At peak stress, a radionuclide (such as thallium or sestamibi) is injected into the patient, who continues to exercise for another minute. The treadmill is stopped and single-photon emission computerized tomography (SPECT) images are obtained.

If the initial images indicate a need for more pictures, the patient may be instructed to return in several hours or the next day for additional imaging, according to the ACC guide. These images are taken at rest, and compared with the stress images taken earlier, to detect myocardial ischemia.

SPECT code 78464 (... single study at rest or stress [exercise and/or pharmacologic], with or without quantification) is for a single study only. Such studies are not often performed, but may be used to determine if heart muscle is still alive and if the patient would benefit from bypass surgery. A single study may also be coded if one test appears completely normal and the cardiologist does not feel a second scan is required.