Cardiology Coding Alert

When cardiologists perform multiple gated acquisition (MUGA) scans to measure various aspects of the heart's muscle function, you should report not only the scan but also any procedures performed at the same time and supplies used to ensure proper reimbursement for the physician's work. CPT lists four codes that may apply to MUGA scans (see box on page 59). Choosing among these codes is only one part of reporting the cardiologist's services for this procedure. Because physicians occasionally perform these scans with stress tests, be sure to report all the work done by the cardiologist, as well as the supplies, says Lisa M. Clifford, CPC, owner of the multispecialty coding firm Clifford Medical Billing Specialists Inc. in Naples, Fla. What Are MUGA Scans? Cardiologists perform MUGA scans to measure ventricular wall motion to determine, for example, if the lower portion of the heart is damaged and, if so, to what extent. The scans can be used to evaluate patients with suspected or known coronary artery disease, valvular heart disease and after a myocardial infarction, among other conditions.

The patient's red blood cells are tagged with a radiographic tracer (usually technetium), which can be photographed with a special camera as they move through the body and synchronized with an electrocardiogram (ECG) taken at the same time. By tracing the blood's flow through the heart, the cardiac physician can determine the ventricle's ejection fraction (how much of the blood in the heart gets pumped out as a percentage of the total amount of the blood filling the heart). The higher the percentage, the better the heart is working. Coding for the MUGA scan will depend on whether the cardiologist performs the study with the patient at rest, with exercise or with pharmacologic stress (e.g., dobutamine). If the physician tests the resting patient once, you should report 78472. Although the CPT definition indicates that the single test may be performed on patients either at rest or stressed, in most cases the cardiologist performs the single procedure on resting patients. Don't Forget to Report Induced Stress The cardiologist can obtain useful data when the scan is performed at rest and after exercise. If the patient cannot perform an adequate level of exertion, he or she may undergo pharmacologic stress, which is brought on by using drugs such as dobutamine. When the cardiologist monitors the patient both at rest and at various levels of exercise, you should report 78473. According to the medical review policy of HGSAdministrators, the Medicare Part B carrier for Pennsylvania, "When cardiac blood pool imaging studies are performed during exercise and/or pharmacologic stress, the appropriate stress testing code from the 93015-93018 series should be paid in addition to the code(s) 78472 [...]