Four Tips Help You Breathe Easier When Coding Lung Scans
Published on Fri Mar 01, 2002
Radiology coders specializing in nuclear medicine have long struggled with the complexities of reporting lung scans. A range of factors impacts the choice of codes, including whether blood or air flow is being measured, which agents are used to help determine the diagnosis (e.g., radioactive particles tagged to an agent in an aerosol or a radioactive gas such as Xenon), and whether a combination of procedures is being performed. In addition, nuclear radiologists sometimes use terminology in their reports that differs from CPT verbiage, adding to a coder's confusion.
Lung scans are most commonly ordered when patients present with chest pain (e.g., 786.50, Chest pain, unspecified), shortness of breath (786.05, Symptoms involving respiratory system and other chest symptoms, dyspnea and respiratory abnormalities, shortness of breath), painful respiration (786.52, painful respiration) or similar symptoms, according to Stacie L. Buck, RHIA, internal auditor for U.S. Diagnostic Inc., a corporation based in West Palm Beach, Fla. These signs might arise if a disease or condition is interfering with the flow of air or blood to the lungs. Depending on the circumstances, a perfusion or a ventilation scan can help determine precisely what's at fault.
Consider Four Points Before Coding Scans
1. Determine whether blood or airflow is being measured. When choosing the appropriate code, the most basic consideration is whether the nuclear radiologist is measuring blood or air flow, says April Brazinsky, CCS, coding specialist for the Community Hospital of the Monterey Peninsula in California. "A ventilation study indicates that the physician is measuring the flow of air in and out of the lungs. This is usually done when conditions like bronchopneumonia (514, Pulmonary congestion and hypostasis) are suspected. On the other hand, a perfusion study is ordered when the radiologist believes that the problem may be within the pulmonary circulatory system, and how effectively the blood is flowing to and through the lungs. Symptoms may suggest a pulmonary embolism (415.1, Acute pulmonary heart disease, pulmonary embolism and infarction), for instance."
2. Perfusion studies rely on radioactive particulate matter. When a simple perfusion study is performed without any additional scans, 78580 (Pulmonary perfusion imaging, particulate) is used. This exam consists of the injection of protein particles tagged with a radioactive material which are carried through the vascular system and trapped by the small arterioles of the pulmonary circulatory system where images are obtained, Buck says. Although commonly conducted by itself, it is also often done in conjunction with ventilation exams.
3. Ventilation studies use radioactive gas or nebulized aerosol agents. Five codes describe simple ventilation studies, depending on whether radioactive gas or nebulized aerosol agents are used to measure the patient's airflow. [...]
