You've Got Myocardial Perfusion Questions?
Published on Fri May 21, 2004
Add-on codes 78478 and 78480 may pay the same, but they describe very different procedures Do you know your wall motion studies from your ejection fraction calculations? If not, you might be assigning the wrong nuclear medicine codes to your charts. The following five frequently asked questions -- and expert answers -- can help you pin down the correct myocardial perfusion imaging codes every time. Question 1: How should we differentiate between the wall motion study codes and ejection fraction calculation codes? Answer: The myocardial perfusion add-on codes can each bring you an estimated $100 extra when you report them with the right perfusion imaging base codes, but you must know the difference between the two codes before you append them. Code +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) describes "the movement (contraction) of specific walls within the heart," says Patricia Gajewski, CPC, full-time coder at Consultants in Cardiovascular Disease Inc. in Erie, Pa. Don't miss: When the physician assesses ventricular function, you should report 78478 with the appropriate main codes for myocardial perfusion and single photon emission computed tomography (SPECT) studies because 78478 is an add-on code. Your primary code should be one of the following: 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 pharmacologic), and redistribution and/or rest injection, with or without quantification 78464 -- ... tomographic (SPECT), single study at rest or stress (exercise and/or pharmacologic), with or without quantification 78465 -- ... tomographic (SPECT), multiple studies, at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification. In contrast to wall motion studies, ejection fraction calculations detail the percentage of blood that the ventricle empties during systole, Gajewski says. For these measurements, report +78480 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]) in addition to 78460-78465, depending on whether the cardiologist performs a single study or multiple studies (see our myocardial perfusion imaging clip-and-save chart on page 43 for more information on choosing the correct imaging code). Question 2: When should we report the add-on codes 78478 and 78480? Answer: You should report 78478 and 78480 if the practitioner performs, interprets and documents additional studies beyond standard perfusion imaging (78460-8465). Some Medicare LMRPs list codes 78478 as Heart wall motion, add-on and 78480 as Heart function add-on, says Cynthia Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist LLP in Omaha, Neb. "The add-on codes report additional tests performed with codes 78460-78465 and describe [...]
