Radiology Coding Alert

Our expert gives you the MPI-vs.-equilibrium coding facts

Myocardial perfusion and cardiac blood pool imaging codes may be grouped together in your CPT manual , but if you report these studies for the same episode of care, you're sure to get a denial, thanks to the most recent National Correct Coding Initiative (NCCI) edits.

The lowdown: NCCI Edits version 12.1, released April 1, added the following edits:
 
You won't be able to use a modifier to override these edits because they all have a "0" modifier indicator (www.cms.hhs.gov/NationalCorrectCodInitEd/).

Take Your Nuclear Med Know-How up a Notch

Good news: If you know how to recognize these services, you should be able to produce clean claims every time. Why? Your nuclear medicine staff is unlikely to perform these tests on the same date because the radiopharmaceuticals required for same-day performance lead to less-than-optimal results.
 
Equilibrium studies: Cardiac blood pool imaging (equilibrium) studies image tagged red cells and evaluate heart function, says Bruce Hammond, CRA, CNMT, executive VP of Texas-based Diagnostic Health Services. The study normally yields ejection fraction and wall motion information, he says.

The procedure involves a nuclear medicine camera taking images, which are timed to the cardiac cycle by ECG. This synchronization produces a derived display of cardiac wall motion by imaging the blood within the cardiac chambers.

The standard equilibrium codes are for left heart function, but with the first-pass add-on code (+78496, Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first-pass technique) you can see right heart function, he says.

You should report 78496 only in conjunction with a performed and documented 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without additional quantitative processing). 

MPI: Myocardial perfusion imaging (MPI) evaluates perfusion of the myocardium, Hammond says. The myocardium is the heart's muscular wall.

Planar MPI (78460-78461) involves a gamma camera imaging the heart to reveal areas of infarction, while SPECT MPI (78464-78465) uses a single- or multi-headed camera that rotates around the patient to give 3D images.

The patient may not need a separate equilibrium study because with gated imaging you can gather ejection fraction and wall motion information, he adds.
 
Report these wall motion and ejection fraction studies with +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study) and +78480 (Myocardial perfusion study with ejection fraction), which you report in conjunction with MPI codes 78460-78465.