Cardiology Coding Alert

Question: How can I tell when I should use 78472 rather than 78473?


California Subscriber

Answers: You should always ask, "Was the test performed when the patient was at rest or stress?" The answer will direct you to the correct code.

For example, if your cardiologist performs the blood pool imaging at rest only, you automatically know that this is a single study.

You may report a single study using 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without additional quantitative processing). Notice the "at rest or stress" section in the descriptor, meaning this service only contains one of these elements.

In contrast, multiple studies include both rest and stress, not just one of these elements. Therefore, rest only means single study. Keep in mind though, for the vast majority, you'll see a multiple study (such as 78473, Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress [exercise and/or pharmacologic], with or without additional quantification).

For 78473, the technician injects the patient, then he takes images while the heart has a regular rhythm, and then again when the heart is at exercise (stress). Keep in mind that you'll report additional codes (93015-93018 and potentially a pharmaceutical stress agent) for the stress procedure.

Note: If you report a pharmacologic stress agent, you'll need to include the reason for using pharmacologic stress in addition to submitting the ICD-9 code that supports the claim. That's also in addition to a copy of the referral order and reason for referral for the test that many carriers also require. Last, don't forget to show compliance with the physician supervision requirements. Check your carrier's policy for more information.