Radiology Coding Alert

This NCCI edit aroused controversy even before taking effect

If you've been reporting 78472, 78465, and 78496, NCCI says you have to change your ways.

According to the latest NCCI Edits , you can no longer report CPT 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without additional quantitative processing) when you report 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification).

Red flag: You won't be able to use a modifier to override this mutually exclusive edit, which has a modifier indicator of "0." Remember: CMS says mutually exclusive means the code pair "represent procedures or services that could not reasonably be performed at the same session by the same provider on the same beneficiary." Medicare will only reimburse you for the lesser-valued of the two procedures.

Problem: To perform a "pass technique" to examine the right ventricle (78496), a physician has to be able to use both cardiac blood pool imaging and myocardial perfusion imaging, says Belinda Inabinet, technical support manager with South Carolina Heart Center in Columbia, S.C. If NCCI forbids providers from coding both 78472 and 78465 in the same session, they won't be able to code for the services associated with +78496 (Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique [list separately in addition to code for primary procedure]).

This edit is based on an outdated understanding of the technology available, Inabinet says. In the past, you couldn't safely perform together the services those three codes describe. But new cameras that came out between 2003 and 2004 make performing both types of imaging on the same day safe, Inabinet says.

Stay tuned: Next month, we'll explore the proper way to code this procedure. Hint: Many physicians don't actually perform 78472, and you may need to use an unlisted-procedure code for the first pass.