Cardiology Coding Alert

Question: We are reporting 78465, 78478 and 78480 along with radiopharmaceuticals and treadmill. I know Aetna will not reimburse both the EF and WM with a SPECT. Am I alone in this?

Delaware Subscriber Answer: You'll find a lot of sympathetic coders, many who have also received denials for the following codes:

 78465-26 - Myocardial perfusion imaging; tomographic (SPECT), multiple studies (including attenuation correction when performed), at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification; professional component
 +78478-26 - Myocardial perfusion study with wall motion, qualitative or quantitative study (list separately in addition to code for primary procedure); professional component
 +78480-26 - Myocardial perfusion study with ejection fraction (list separately in addition to code for primary procedure); professional component. You should report 78478 and 78480 if the cardiologist performs, interprets and documents additional studies beyond the standard perfusion imaging code (such as, 78465). For instance, the wall motion code (78478) represents the actual assessment of watching the heart beat. The ejection fraction (78480) is the number that's generated from the wall motion study. Some Medicare LMRPs list codes 78478 as Heart wall motion add-on and 78480 as Heart function add-on.
 
Note: You should never report these add-on codes with 78466 (Myocardial imaging, infarct avid, planar; qualitative or quantitative), 78468 (... with ejection fraction by first pass technique) or 78469 (... tomographic SPECT with or without quantification). These codes represent an older technology that is more limiting in what it shows cardiologists.
 
Keep in mind: Sometimes the hospital will use one physician for the supervision and interpretation, while another does the readings later in the day. You may want to wait to code this test until the procedure reports come over from the hospital.