Pulmonology Coding Alert

Question: Our physician performed a differential ventilation/perfusion scan (or V/Q study). We know how to report the standard scan with 78579, but we aren’t sure how to bill the differential service. Can you advise?

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Answer: Differential scans help the provider quantitatively measure and compare the perfusion and ventilation of the two lungs in patients with lung pathology resulting in unequal distribution of blood flow or air flow in the two lungs.

Differential perfusion scan: If the physician ordered differential scans, you may report code 78597 (Quantitative differential pulmonary perfusion, including imaging when performed) for a comparative lung perfusion study using a radiopharmaceutical to measures relative distribution of pulmonary arterial blood flow in each lung.

Differential V/Q scan:  If the provider opts for both differential pulmonary perfusion and ventilation study, you may report code 78598 (Quantitative differential pulmonary perfusion and ventilation [eg, aerosol or gas], including imaging when performed).

Code 78598 represents the same work as 78597, along with addition of a differential ventilation study.

Important: Both these codes include imaging when performed and you cannot report any additional codes for the imaging. The imaging can be a magnetic resonance imaging (MRI) or other radiological imaging that your radiologist obtains during the scan.