Cardiology Coding Alert

Watch for this variation to the Ultratag kit.

Set aside a little time to confirm your MUGA coding skills are still top notch. Review this sample scenario, and then see how your answer compares to the expert's.

Scenario: The cardiologist performs a nuclear medicine MUGA scan using TC-99m pertechnetate diagnostic. He administers 30 millicuries during the procedure. He also uses a cold pyrophosphate solution kit. He doesn't use the Ultratag kit.

Set Your Sights on the Solution

For the MUGA (multiple gated acquisition) scan, you should report 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), says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CEMC, CCC, CMSCS, CMC, a healthcare coding consultant in Laguna Beach, Calif.

The cold pyrophosphate solution coding is not as simple. Some payers may consider this incidental to the procedure and won't allow you to report it separately, notes Fletcher. For those that do, check their coding preference. For example, Part B Medicare contractor WPS has a policy stating you should report A9560 (Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries) whether the physician uses Ultratag or cold pyrophosphate.

The Ultratag method (in vitro) involves drawing the patient's blood and transferring it to a bag or vial, and then adding the pertechnetate. Roughly 25 minutes later the patient is injected with the labeled red blood cells.

In the cold pyrophosphate method (in vivo), the patient is injected with the pyrophosphate and 20 minutes later is injected with the pertechnetate.

Watch out: For the pertechnetate, the proper code is A9512 (Technetium Tc-99m pertechnetate, diagnostic, per millicurie), Fletcher says. You should report one unit per millicurie used, so you should report 30 units, she adds.

But again, you need to watch payer policy. The WPS policy goes on to say that A9512 will not be paid when billed alongside A9560 because the pertechnetate is included (http://www.wpsmedicare.com/part_b/policy/active/local/_files/l7388_l20787_l20788_l20789_rad026_cbg.pdf). But other payer policies may vary and allow you to report A9512 and A9560.