Radiology Coding Alert

Question: Due to the shortage of CCK for the nuclear medical study (78227), we weren’t able to use it but we instead used a fatty meal. During the procedure, ejection fraction was being calculated. Can we still charge 78227? Please advise if we need to switch to code 78226?

Alaska Subscriber

Answer: You are reporting an imaging with intervention. However, you need to be clear about the intervention. Generally, an intervention refers to a “drug” administered DURING the procedure. Fatty meals and water are not considered to be pharmacologic. There are different opinions on reporting of such procedures. Most experts have suggested not to report 78227 (Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement[s] when performed) if there’s no pharmacologic intervention because use of a pharmacological entity is the major distinguishing factor between 78226 (Hepatobiliary system imaging, including gallbladder when present) and 78227. The quantitative measurements aren’t required by the definition but are included in 78227 if performed.