Pulmonology Coding Alert

Question: Our pulmonologist was called in to perform a perfusion imaging with aerosol ventilation and lung perfusion. He took two projections. How can we report this procedure?

Oklahoma Subscriber

Answer: For pulmonary ventilation/perfusion imaging with aerosol ventilation and lung perfusion, you can submit code 78582 (Pulmonary ventilation [e.g., aerosol or gas] and perfusion imaging). This code combines the procedures described in codes 78579 (Pulmonary ventilation imaging [e.g., aerosol or gas]) and 78580 (Pulmonary perfusion imaging [e.g., particulate]). You report one unit of 78582 when your physician performs the imaging twice, once after the patient inhaled a radioactive aerosol and another after the patient was injected with a radioactive particulate. Imaging after each administration is required for this code.

During the pulmonary ventilation/perfusion procedure, your physician performs both pulmonary ventilation and perfusion nuclear scan tests that evaluate the circulation of air and blood within the patient’s lungs. The aim is to perform quantitative analysis of differential pulmonary ventilation and perfusion in the lungs. This combined study is commonly performed to evaluate chronic obstructive pulmonary disease, pneumonia, bronchitis, or other infections.

If the physician has performed both the ventilation and perfusion using quantitative differential testing, you can report or 78598 (Quantitative differential pulmonary perfusion and ventilation [e.g., aerosol or gas], including imaging when performed). For reporting just the perfusion, you will report 78597 (Quantitative differential pulmonary perfusion, including imaging when performed). You can submit codes 78582-78598 only once irrespective of how many projections your physician performed. In quantitative differential testing, the aim is to perform a quantitative analysis of differential pulmonary artery blood flow to rule out pulmonary stenosis. The provider can also perform this test with MRI or other radiologic imaging.