Radiology Coding Alert

Version 9.1 of the National Correct Coding Initiative (NCCI), which took effect April 1, bundles several nuclear medicine codes (78472-78496) into one another. These edits are considered "mutually exclusive," which means Medicare will never pay for these services if you report them together. The good news, however, is that you probably aren't reporting these services together anyway. "The nuclear medicine edits look extensive, but in reality, most carriers were already denying these services when reported together," says Heather Corcoran, coding manager at CGH Billing Services, a medical billing firm in Louisville, Ky. The following edits affect nuclear medicine practices:

1. Medicare will deny +CPT 78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study) and +78480 (Myocardial perfusion study with ejection fraction) if you bill them with any of the following CPT codes :
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)
78473 ... multiple studies, wall motion study plus ejection fraction, at rest and stress [exercise and/or pharmacologic], with or without additional quantification
78481 Cardiac blood pool imaging [planar], first pass technique; single study, at rest or with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification
78483 ... multiple studies, at rest and with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification
78494 Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing
+78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique. 2. The NCCI now bundles codes 78473 and 78483 into 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification). 3. Medicare now considers 78461 (Myocardial perfusion imaging; multiple studies [planar] at rest and/or stress [exercise and/or pharmacologic], and redistribution and/or rest injection, with or without quantification) and 78494 components of codes 78473 and 78483. Most carriers already bundled these services into one another. The local medical  review policy (LMRP) for Triple-S Inc., Puerto Rico's Part A carrier, states, "Only one code from the group 78472, 78473, 78481, 78483 can be used on a given day, and that one code cannot be billed with any of the codes 78460 through 78469 (Myocardial perfusion imaging), 78478 and 78480."

In addition, the NCCI now bundles 78472 and 78480 into 78494. According to the June 1999 CPT Assistant , the technology described by code 78494 "provides the added benefit of three-dimensional imaging, in contrast to the two-dimensional imaging [...]