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Answer: For oncology practices, measures of myocardial contractility, thinning and dilatation are important in the titration of therapeutic agents with known myocardial toxicity. Baseline assessment prior to treatment at regular intervals and after treatment with cardiac toxic therapy is generally considered medically appropriate.
MUGA scans are ordered if patients are receiving specific classifications of cardiotoxic chemotherapy agents. The primary drugs that can damage heart muscle are anthra-cyclines Adriamycin and doxorubicin (J9000-J9001), and mitoxantrone (J9293). MUGA prior to anthracycline therapy is an industry norm; in fact, not getting a baseline and comparative studies during therapy can be viewed as malpractice. MUGA scans are ordered for heart assessment prior to and during treatment that can be heart-toxic. You can code to the chemotherapy. In Texas, code MUGAs using V58.1 (Encounter for chemotherapy).
Blood pool studies such as MUGA scans evaluate the heart's structural cavity. The basic blood pool imaging scan involves extracting red blood cells from the body, labeling the blood cells with radioactive material and returning them to the cardiovascular system for imaging. Usually, ventricular function is the object of the blood pool scan.
There are five blood pool imaging codes to choose from, but the one you will want to use is 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic] ... with or without additional quantitative processing), also known as an MUGA scan. It's called a "gated" study because it takes images that are synchronized with an EKG.
The ejection fraction is included in the blood pool imaging study. The ejection fraction (+78480, Myocardial perfusion study with ejection fraction), which calculates how much blood the heart is pumping out to the rest of the body, always shows up in a patient chart as a percentage. Do not submit this add-on code in addition to 78472.
Medicare allows echocardiography to measure these toxic effects of chemotherapy. Echocardiography is a two-dimensional imaging that defines the configuration and changing dimensions of the chambers, dynamic cyclic variation in myocardial thickness, and the associated valve motions throughout the cardiac cycle. Coverage includes obtaining ultrasonic signals from the heart and great arteries, with two-dimensional image and/or Doppler ultrasound signal, documentation, and interpretation of results. Medicare covers a variety of echocardiography codes:
93307 Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording; complete
93308 ... follow-up or limited study
+93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete
+93321 ... follow-up or limited study (list separately in addition to codes for echocardiographic imaging)
+93325 Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography).
Denials for these procedures usually relate to failure to provide the proper diagnosis code or medical-necessity documentation when the condition is not listed as a covered diagnosis. |
