Cardiology Coding Alert

Plus, you finally get your own code for Lexiscan.

Just last month, Cardiology Coding Alert discussed the pitfalls of choosing units for Myoview: Do you report one unit "per study dose" or one unit for "up to 40 millicuries"? The HCPCS descriptor includes both phrases and different payers have their own interpretations. Well, HCPCS took a step to clear the confusion and make your life a little easier. Here's the scoop on Myoview, as well as two more HCPCS changes you need to know.

HCPCS 2009 revises the code for Myoview by deleting the phrase "up to 40 millicuries":

• 2008: A9502 -- Technetium Tc-99m tetrofosmin, diagnostic, per study dose, up to 40 millicuries

• 2009: A9502 -- Technetium Tc-99m tetrofosmin, diagnostic, per study dose.

Impact: You should be able to eliminate some of the math from your Myoview claims in 2009, reporting one unit of A9502 per study, even if the patient receives more than 40 mCi for that one study.

But be sure to watch your payer guidelines. As noted in Cardiology Coding Alert, Vol. 12, No. 1, certain payers consider a rest study with a stress study to be a single study and may deny a second unit of A9502. Time will tell whether they will change this in 2009.

SNM's say: In comments to the HCPCS workgroup, Kenneth McKusick, MD, FACR, FACNP, the Society of Nuclear Medicine (SNM) AMA CPT advisor, along with the American College of Radiology (ACR) AMA CPT advisor, applauded the idea of deleting the "up to" amount for myocardial perfusion imaging radiopharmaceuticals.

In comments on another code, SNM stated that including "up-to-amount" doses have caused a lot of confusion, raising questions about how to code more than 40 mCi in a single study and leading to payers allowing only one unit even for multiple studies.

"The SNM is pleased with the deletion of the up to amount for tetrofosmin [A9502]; however, we are disappointed that CMS did not extend this to the other myocardial perfusion agent, sestamibi [A9500, Technetium TC-99m sestamibi, diagnostic, per study dose, up to 40 millicuries]," confirms Denise A. Merlino, MBA, CNMT, FSNMTS, CPC, SNM's coding advisor and president of Merlino Healthcare Consulting Corp.

Resource: You can find the SNM and ACR comment letter online at http://interactive.snm.org/docs/FinalMay12_2008SNM_ACRHCPCS%20meetingfollowup%20(3).pdf.

Thanks to another HCPCS change, reporting Lexiscan -- used for patients who can't exercise sufficiently for a stress test -- should be simpler in 2009.

For 2008 services, for the physician office or independent diagnostic testing facility, you report J3490 (Unclassified drugs), as Sarah Tupper, CMC, coder for Central New York Cardiology in Utica, explained in last month's issue.

This held true even when CMS announced C9244 (Injection, regadenoson, 0.4 mg) because this C code was for use in the hospital outpatient setting only.

HCPCS 2009 simplifies your coding by deleting C9244 and creating a specific code for Lexiscan that you should use regardless of setting: J2785 (Injection, regadenoson, 0.1 mg).

Watch units: The recommended dose of Lexiscan is 0.4 mg. Hospitals reported one unit of C9244 for 0.4 mg. But for J2785, you should report one unit for every 0.1 mg.

If you ever report tenecteplase (brand name TNKase), which cardiologists use to reduce mortality in acute myocardial infarction patients, there's one more change you need to know.

You have a new code to use in 2009, and rather than reporting one unit for 50 mg or less, you'll report one unit per milligram:

• 2008: J3100 -- Injection, tenecteplase, 50 mg

• 2009: J3101 -- Injection, tenecteplase, 1 mg.

So if the cardiologist decides a 130 pound patient should have only 30 mg, you'd report 30 units of J3101 in 2009.

Resource: You can find the HCPCS update on the CMS Web site at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS.