Radiology Coding Alert

Even though myocardial perfusion imaging may have several segments and extend over hours or even days, it must be assigned only a single CPT code. So says Kenneth McKusick, MD, FACR, noting that it makes no difference when components of the test are conductedmultiple, sequential-day myocardial perfusion exams are usually considered a single study.

The following explanation of the test, and its variables, clarifies why reimbursement policies recognize myocardial perfusion imaging as a single procedure.

Four CPT Codes Describe Testing Procedures

Four basic codes can be assigned during myocardial perfusion scans, says McKusick, who is retired from the Massachusetts General Hospital and now a member of the American Medical Association CPT Codes Advisory Committee, representing the Society of Nuclear Medicine. These can be categorized into two sets, he explains. Two codes can be used when two-dimensional, or planar, imaging is done, and two different codes are used when three-dimensional, or SPECT, imaging is done.

78460 : myocardial perfusion imaging; (planar) single study, at rest or stress (exercise and/or pharmacologic), with or without quantification;

78461: multiple studies (planar) at rest and/or stress (exercise and/or pharmacological), and redistribution and/or rest injection, with or without quantification;

78464: tomographic (SPECT), single study, at rest or stress (exercise and/or pharmacological), with or without quantification;

78465: tomographic (SPECT), multiple studies (planar) at rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification.

Although there are a number of variables in the exam itself, McKusick says, the coding is quite straightforward. If both the resting and stress tests are performed, you still use either the 78461 or 78465 code, whether you separate it by just a few hours or by a full 24 hours.

He added that Medicare and insurance carriers might consider assigning a single test code twice, separated by 24 hours, to be a classic example of unbundling.

Additional Studies May Also be Billed

Medlearns book Nuclear Medicine Coder, by Jeff Majchrzak, BA, RT, NMTCB, also reports that wall motion and ejection fraction studies may be done in conjunction with the base planar or SPECT scansand billed as additional procedures.

Wall motion tests measure the movement of the left ventricle from systole to diastole. Systole refers to left ventricular contraction, when that chamber is compressed to its smallest volume, and oxygen-rich blood is circulated from the heart to the rest of the body.

Diastole refers to the second half of the circulation cycle, when re-oxygenated blood is returned [...]