Pulmonology Coding Alert

Coding a pulmonary perfusion or ventilation imaging procedure is less challenging after you discover code 78588 (pulmonary perfusion imaging, particulate, with ventilation imaging, aerosol, one or multiple projections). For the most part it eliminates the need to ever use modifier -52 to code for reduced services.

If a patient presents with shortness of breath and syncope, the physician may perform a ventilation/perfusion lung scan to explore the possibility of pulmonary embolism. The patient would receive an intravenous injection of albumin tagged with radioactive material. After the patient inhales a radioactive gas or nebulized aerosol, it is trapped by the small arterioles of his or her pulmonary circulation. Multiple images of the lungs would be performed to assess lung perfusion.

According to Kevin Carney, RN, at Temple University Hospital, Temple Pulmonary Center, Philadelphia, the radioactive aerosol in pulmonary perfusion imaging helps determine blood flow to the lungs. A perfusion scan is a less invasive procedure, he says, one that he considers a diagnostic for perhaps a pulmonary embolus.

A perfusion scan determines whether theres a mismatch between the perfusion and the ventilation in the lung, Carney states. We also use it for patients being evaluated for lung volume reduction surgery to see if there are any parts of the lung that have low perfusion.

Perfusion scans almost always are performed with a lung ventilation scan to detect a characteristic pattern of perfusion deficits. Together, these procedures provide an accurate noninvasive screening test both for the detection of emboli and for documentation of resolution during and after therapy. Lung ventilation also is helpful in quantifying regional pulmonary ventilation in patients with severe obstructive lung disease or who are being considered for lung resection surgery.

Stacey Hall, RHIT, CPC, CCS-P, Medical Management Professionals Inc., Knoxville, Tenn., a billing firm for physicians, recommends reporting code 78588, which combines codes 78580 (pulmonary perfusion imaging, particulate) and 78586 (pulmonary ventilation imaging, aerosol; single projection) for lung ventilation and perfusion scans. Should a patient require more than one course, report 78587 (pulmonary ventilation imaging, aerosol, multiple projections).

Code 78588 represents a combined procedure to determine both pulmonary perfusion and ventilation. Report code 78588 when a patient is imaged twice: once after inhalation of a radioactive aerosol to determine pulmonary ventilation and again after injection of a radioactive particulate to determine lung perfusion.

Note that code 78584 (pulmonary perfusion imaging, particulate, with ventilation; single breath) is acquired into code 78585 (rebreathing and washout, with or without single breath), says Walter ODonohue, MD, FCCP, representative to the AMA CPT Advisory Committee for the American College of Chest Physicians. What this means, he says, is that code 78585 is reported when a re-breathing and washout is done as part of 78584. The two codes represent different phases. If the washout and re-breathing are not performed, report code 78584.

You Probably Wont Need to Use Modifier -52

ODonohue states that its important to note that the code descriptor for code 78588 also includes the phrase single or multiple projections. He says this means that you should report code 78588 regardless of the number of projections that were performed as part of the pulmonary perfusion procedure. This helps eliminate the misuse of modifier -52 to indicate reduced services. If you do the ventilation imaging using aerosol and a single projection, he says to report CPT code 78586.

If you do only one part of that procedure, theres a code for just perfusion (code 78580) and theres a code for just ventilation (78586). Theres no need to put a modifier -52 if youve done just one part of the procedure, says Hall.

Editors note: The procedures listed do not include the provision of radioelements. Materials supplied by the physician should be listed separately and identified by the code 78990, (provision of diagnostic radiopharmaceutical(s)).