Cardiology Coding Alert

Question: How should we differentiate between the wall motion study codes and ejection fraction calculation codes?

Virginia Subscriber

Answer: Code +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) describes the movement (contraction) of specific walls within the heart. In contrast to wall motion studies, ejection fraction calculations detail the percentage of blood that the ventricle empties during systole.
 
Don't miss: When the physician assesses ventricular function, you should report 78478 with the appropriate main codes for myocardial perfusion and single photon emission computed tomography (SPECT) studies because 78478 is an add-on code.
 
Your primary code should be one of the following:

• 78460 -- Myocardial perfusion imaging; (planar) single study, at rest or stress (exercise and/or pharmacologic), with or without quantification

• 78461 -- ... multiple studies, (planar) at rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification

• 78464 -- ... tomographic (SPECT), single study, at rest or stress (exercise and/or pharmacologic), with or without quantification

• 78465 -- ... tomographic (SPECT), multiple studies, at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification.

For ejection fraction measurements, however, you should report +78480 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]) in addition to 78460-78465, depending on whether the cardiologist performs a single study or multiple studies.
 
Cash in: The myocardial perfusion add-on codes can each bring you an estimated $100 extra when you report them with the right perfusion imaging base codes, but you must know the difference between the two codes before you append them.

 -- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C