Cardiology Coding Alert
PET Coverage Varies by Scanner Type
The type of equipment the cardiac physician uses for PET scans is vital because it will affect the codes some payers want you to use, says Melody Mulaik, MSHS, CPC, RCC, a coding specialist with Atlanta-based Coding Strategies Inc. Medicare specifies that it will pay for PET scans on U.S. Food and Drug Administration (FDA)-approved scanners only when a SPECT does not reveal enough information about heart muscle viability. According to the memo, FDA-approved means that the system has been cleared to image radionuclides in the body and that "coincident systems" must have the following features: Medicare will not cover scans performed with gamma camera PET systems with crystals thinner than 5/8 inch or lacking in the other two design features, the memo states. Mulaik suggests that coders who have concerns about whether equipment used in PET scans meets CMS criteria should talk to the cardiologist or appropriate hospital personnel because coders will need the appropriate equipment to support the codes they're assigning. This is particularly important if coders are using the new HCPCS code for gamma cameras used in myocardial imaging: G0230 (PET imaging; metabolic assessment for myocardial viability following inconclusive SPECT study; full- and partial-ring PET scanners only).
In a program memorandum issued Nov. 27, 2001, (AB-01-168), CMS stated that after Jan. 1, 2002, it would cover FDA-approved full-ring and partial-ring scanners for determination of myocardial viability following an inconclusive SPECT. In a nutshell, this memo added new HCPCS codes that clarify the kind of PET scan used for clinical indications, including cardiology imaging, Mulaik explains.
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