Pulmonology Coding Alert

Question: Our physician documented a “V/Q study.” What is this and which code applies to it? We didn’t see anything in CPT® about it.

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Answer: A pair of nuclear scan tests — known as the pulmonary ventilation/perfusion (V/P) scans — measure two things: the distribution of blood within the capillaries surrounding the alveoli in the lungs (perfusion), and the distribution of oxygen within the same alveoli (ventilation). The provider administers a small amount of low-risk radioactive substance through inhalation in the ventilation scan, or injection in the patient’s arm in the perfusion scan. The provider may perform these tests separately or together. Typically, perfusion and lung ventilation scans almost always go together, to detect characteristic patterns of perfusion deficits and emboli and for documentation of resolution during and after therapy.

During the procedure, the provider obtains images after the patient inhales an aerosol with a radiopharmaceutical to evaluatepulmonary ventilation and takes images again after injection of a radioactive particulate to determine lung perfusion.

In this scenario, you should report the combination code 78582 (Pulmonary ventilation [e.g., aerosol or gas] and perfusion imaging). If you are only reporting the professional supervision and interpretation, please be sure to append modifier 26 to the code.