Radiology Coding Alert

Radiology practices that perform multiple gated acquisition (MUGA) scans for cardiac evaluation should note whether the patient is resting or exercising and the number of scans required, before selecting the appropriate MUGAscan code.

Radiologists perform MUGA studies on patients with either known or suspected underlying disease or before, during or after cancer treatment with cardiotoxic drugs. If you test the patient once (either resting or with stress), report 78472 for planar imaging, or if you perform a resting study using SPECT, report 78494. Although the CPT Codes definition indicates that the single test applies to patients either at rest or stressed, in most cases (particularly for cancer patients) the radiologist performs the single procedure on resting patients. If you perform the study after stress only with no resting images, you should still report 78472.

Don't Forget to Report Induced Stress

Radiology technicians sometimes perform MUGAscans both at rest and after the patient exercises. If the patient cannot exert himself adequately, the physician may use drugs such as dobutamine to induce pharmacologic stress.

When the physician monitors the patient both at rest and at various levels of exercise, report 78473. According to HGSAdministrators'(the Medicare Part B carrier for Pennsylvania) policy, When cardiac blood pool imaging studies are performed during exercise and/or pharmacologic stress" the appropriate stress testing code from the 93015-93018 series should be paid in addition to the code(s) ... 78472 [and] 78473."

The stress testing CPT 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise continuous electrocardiographic monitoring and/or pharmacological stress; with physician supervision with interpretation and report) 93016 (... physician supervision only without interpretation and report) and 93018 (... interpretation and report only) but if a cardiologist or cardiologist-employed nurse or physician assistant performs these stress services (including the ECG interpretation) those professionals should report the stress testing codes.

For example the radiologist performs a MUGAscan on a resting 65-year-old patient with congestive heart failure. The physician then injects the patient with dobutamine to induce stress because the individual cannot exercise to a sufficient exertion level and the radiologist then performs another MUGAscan.

You should report this procedure using 78473 says Alice Church CCS-P coding and reimbursement analyst at Wolcott Wood & Taylor a medical billing firm in Chicago because you ran scans during both rest and stress. You should link the codes to the congestive heart failure diagnosis (428.0 Congestive heart failure; or 428.1 Left heart failure). And because the radiologist performed and supervised the stress portion of the test you should also report 93016.

Report V Codes for Baseline MUGA

Oncologists often refer cancer patients for MUGA studies to rule out heart abnormalities before beginning chemotherapy treatments and to act as a baseline before administering cardiotoxic medications. Because these studies cannot be billed as a follow-up to chemotherapy or radiation therapy many practices perceive them as unreimbursable because the ICD-9 manual does not include diagnosis codes for "baseline" MUGA studies. Your best bet is to report a V code to describe the reason for the MUGA scan.

"We report V81.0 (Special screening for ischemic heart disease) followed by a secondary diagnosis code for the patient's neoplasm if we have that information " says Roxann Zellers CPC consultant at SVAConsulting Inc. a reimbursement consulting firm in Rockford Ill. For instance if you perform a baseline MUGAstudy on a liver cancer patient report V81.0 followed by 155.0 (Malignant neoplasm of liver primary).

"Although V81.0 is not on our carrier's local medical review policy (LMRP) for MUGAstudies in the absence of other symptoms or history if the exam is strictly screening for ischemic heart disease this is the appropriate code to use " Zellers says. If your LMRPdoes not support the reason for the study you should obtain an advance beneficiary notice (ABN) so you can bill the noncovered service directly to the patient in the event of a denial.

Other radiologists report success using V81.2 (Special screening for cardiovascular respiratory and genitourinary diseases; other and unspecified cardiovascular conditions) when testing for a heart condition that does not produce ischemia.

If the patient is already on chemotherapy report either V67.2 (Follow-up examination following chemotherapy) or V58.69 (Long-term [current] use of other medications) depending on your carrier's direction and list the chemotherapy drug in box 19 of the CMS-1500 form Church advises. Other medical review policies list V58.1 (Encounter for chemotherapy) as a payable diagnosis code for these tests.

Report Pharmacologic Agents

If the radiologist uses drugs to induce stress for the multiple MUGAstudy bill for the drug separately (report J1250 for dobutamine). The physician's documentation however must demonstrate medical necessity to justify using the pharmacologic stress agents.

Note: If you perform the procedure in a hospital or other facility it will report the medication supply as a technical-only item and you should not report J1250 in this case.

Radiologists usually administer UltraTag a technetium-TC 99m-based agent as the radiographic tracer for the scan. Report the UltraTag with A4641 (Supply of radiopharmaceutical diagnostic imaging agent not otherwise classified). Because this is an unclassified-drug code you may be required to include the product description the National Drug Code and the invoice with your claims for this drug.

Carriers have the final say regarding which supplies they will reimburse so you should check with your insurer to determine if it will pay for your supplies.