Radiology Coding Alert

Keep an eye out for this legit $40 boostYou can prepare for complicated nuclear medicine claims by challenging yourself with this real-life example. Read the report, and decide which codes you would submit before you go any further. Then check your answers against our experts'.Analyze the Report, Decide Your CodesProcedure: Rest/stress myocardial perfusion SPECT study with gated wall motion analysis and calculation of the ejection fractionIndication: Preoperative evaluationTechnique: A two-day protocol was used. Millicuries of Tc99m sestamibi was injected for rest images and millicuries Tc99m sestamibi was injected at peak exercise.The patient exercised for 10 minutes of the Bruce protocol achieving 86 percent of the maximum predicted heart rate, stopping due to fatigue. No diagnostic electrocardiographic changes were seen. During the test, patient experienced no abnormal symptoms.Scintigraphic findings: Homogeneous uptake of the radioisotope is seen throughout the myocardium.The summed stress score is 0, the summed difference score is 0, and the TID ratio is normal.Gated wall motion analysis shows normal wall motion and thickening. LV volume is normal. The calculated left ventricular ejection fraction is greater than 70 percent.Impression: Normal rest/stress myocardial perfusion SPECT study.Find All Possible CPT Codes for Full PayThis sample report documents a myocardial perfusion SPECT study at rest and stress, with gated wall motion analysis and ejection fraction calculation.You should 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) for the tomographic (SPECT) myocardial perfusion imaging study, says independent coding consultant and instructor Linda Templeton, CCS-P, CPC, CPC-H, who also codes nuclear medicine procedures for a large teaching hospital in southeast Michigan.Don't miss: You may report +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study) and +78480 (Myocardial perfusion study with ejection fraction) separately for the wall motion and ejection fraction (EF), says Cheryl Klarkowski, RHIT, CPC, coding specialist with Baycare Health Systems in Wisconsin.Codes 78478 and 78480 represent services separate and distinct from 78465, Templeton says, citing the AMA's October 2004 CPT Assistant.And forgetting to include these codes means you're letting roughly $40 go down the drain for professional services, according to national payment rates listed on the Medicare physician fee schedule, online at http://www.cms.hhs.gov/pfslookup.Modifier tip: Remember to append modifier 26 (Professional component) if you're only reporting the professional services, Templeton says.Documented Diagnosis Will Bring PaymentIf you typically shudder when you have to choose an ICD-9 code for a "normal" study, you're in luck with this pre-op evaluation.Code V72.81 (Preoperative cardiovascular examination) is a Medicare payable diagnosis, and most insurance companies will accept it, Klarkowski says.Tip: If the physician did document findings in the impression, you should report that diagnosis in [...]