Oncology & Hematology Coding Alert

Question: How should we bill for thallium and multiple-gated acquisition (MUGA) scans?
            
Colorado Subscriber

 
Answer: Thallium scans include 78460-78465, depending upon whether they are single or multiple determinations, planar images, or single-photon emission controlled tomography (SPECT). In general, the administration of the radiopharmaceutical is not separately paid for in nuclear medicine studies. If the scans are performed in a freestanding center, a separate code may be assigned for the supply of the radiopharmaceutical.
 
Practices may report four codes for thallium scans:

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

  78461 ... multiple studies, (planar) at rest and/or stress (exercise and/or pharmacologic), and redistri-   bution 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 pharma-  cologic) and redistribution and/or rest injection, with   or without quantification.
 
 
Multiple-gated acquisition scans include 78472-78473, 78481 and 78494. The variables in code assignment include whether the test is gated (coordinated to an electrocardiogram [ECG]), performed via first pass technique, or SPECT. The above codes refer to four procedures:

  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

  78473 ...  multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification

  78481 Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or with stress    (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification

  78494 Cardiac blood pool imaging, gated    equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing.

 
Because MUGA studies include wall motion and ejection fraction, add-on codes 78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) and 78480 ( with ejection fraction ) are not assigned with these services.
 
The following HCPCS codes may be used. These drugs are used with MUGA and can be reported when used, but the cost of supplies (i.e., kits) used to administer the drugs cannot be billed because it is in included in the drug code:

  A9505 Thallous chloride TL-201, per microcurie
  A9500 Technetium Tc 99m sestamibi, per dose (there are more types of    Tc, but this is the most common)
  A4641 Supply of radiopharmaceutical diagnostic imaging agent, not    otherwise classified
  J1245 Dipyridamole (stressing agent)
  J3490 Unclassified drugs
  J1250 Dobutamine (stressing agent).