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 [...]