Radiology Coding Alert

Watch for the phrase 'when performed' to keep denial-causing codes off your claim.

In last month's issue (Part 1), the spotlight was on how to differentiate SPECT and planar services to help you choose between CPT 78452 and 78454. Now, master which codes you should -- and shouldn't -- report alongside these myocardial perfusion imaging (MPI) codes and understand why thorough documentation is still a must, even when it won't change your coding.

Subtract Add-On Codes From MPI Claims

Aside from the SPECT/planar difference, these codes' definitions are the same, stating they include "qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed":

Crucial: Heed the two words "when performed," which indicate the codes are appropriate whether the physician provides those services or not, says Cynthia A. Swanson, RN, CPC, CEMC, CHC, senior manager, healthcare consulting, at Seim Johnson in Omaha, Neb. And if the radiologist does perform those services, you should not code them separately.

This is a major change from 2009, when you would have reported those services with codes such as the now deleted +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study ...) and +78480 (Myocardial perfusion study with ejection fraction ...).

Opportunity: Although 78452 and 78454 do include many services, you should continue to report the stress test (93015-93018, Cardiovascular stress test ...), the stress-inducing agent (such as Lexiscan, J2785, Injection, regadenoson, 0.1 mg), and radiopharmaceuticals (such as A9500, Technetium, Tc-99m sestamibi, diagnostic, per study dose) if you provide them.

Dig Into 78452, 78454 Documentation Do's

Although performing wall motion and ejection fraction services won't change your physician's reimbursement, that doesn't mean she shouldn't document the services. "Best practice is to routinely document all services provided," says Swanson. "The new 2010 codes (78452 and 78454) include a detailed definition of each service as it relates to myocardial perfusion imaging services. By documenting the various components of testing performed, the medical record will accurately support the service(s) provided to coincide with the CPT code selected."

Reasons for needing thorough documentation include "the medical record serving as a legal document, information regarding the patient's care, evidence of service(s) provided in defense of insurance fraud or malpractice, support for levels of care and support for services performed to payers," Swanson says.

Categorize 78452, 78454 as Multiple Studies

As stated in Part 1, 78452 and 78454 are specific to multiple-study MPI. CPT also provides single-study codes:

So if the radiologist performs and documents only a single study, such as at-rest only, you should report 78451 or 78453 rather than 78452 or 78454.