Correctly Coding Lung Scans Avoids Denials/Abuse Charges
Published on Tue Feb 01, 2000
Coding professionals must stay up-to-date on changes in the coding of lung scans and recognize when to use codes assigned to comprehensive procedures like CPT Codes 78588 (pulmonary perfusion imaging, particulate, with ventilation imaging, aerosol, one or multiple projections) as opposed to component codes, which describe only portions of combined procedures. To avoid charges of unbundling, do not use other codes in addition to 78588.
According to Cheryl Schad, BA, CPCM, CPC, owner of Schad Medical Management, a billing and coding consulting firm located in N.J., ventilation studies often are ordered to diagnose conditions like pulmonary embolism and infarction (415.1), bronchopulmonary sequestration (748.5) or pulmonary trauma (861.20). When a patient presents with chest pain, shortness of breath, painful respiration or similar symptoms, the physician will suspect one of these problems, Schad says. A perfusion and/or ventilation scan can help determine precisely whats going on.
A variety of studies may be performed, depending on specific indications, she adds. The radiologist may choose to study perfusion, which relates to the flow of blood to the lungs, or may wish to investigate ventilation, which relates to the flow of air in and out of the lungs. In most instances, various ventilation tests will be combined with a perfusion study.
Single Code to Describe Perfusion Studies Alone
A simple perfusion scan consists of the injection of particles tagged with a radioactive material, which are trapped by the small arterioles of the pulmonary circulatory system, according to Kenneth McKusick, MD, FACR, retired from the Massachusetts General Hospital and currently a member of the American Medical Association CPT advisory committee, representing the Society of Nuclear Medicine. Multiple images then are acquired to assess lung perfusion. This procedure, conducted by itself, would be coded 78580 (pulmonary perfusion imaging, particulate).
Ventilation Studies Coded According to Inhalant
Ventilation studies may be conducted using either radioactive gas or nebulized aerosol agents, says McKusick. Patients inhale one of these substances, and the images are taken to evaluate the ventilation capacity of the lungs.
Two codes are used to describe aerosol ventilation studies, he notes. Codes 78586 (pulmonary ventilation imaging, aerosol; single projection) and 78587 (multiple projections [e.g. anterior, posterior, lateral views]).
Three codes may be assigned to gaseous ventilation studies, McKusick says. They are 78591 (pulmonary ventilation imaging, gaseous, single breath, single projection), 78593 (pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; single projection) and 78594 (pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; multiple projections [e.g., anterior, posterior, lateral views]).
Bundled Codes Describe Combined Scans
When the documentation indicates that both perfusion and ventilation scans are conducted in conjunction with one another, there are three codes that may be assigned. The key [...]
