Pulmonology Coding Alert

Question: Our physician performed pulmonary ventilation/perfusion imaging with aerosol ventilation and lung perfusion. Which code should I use and how many times (e.g., for two projections)?

Idaho Subscriber

Answer: You can use code 78582 (Pulmonary ventilation [e.g., aerosol or gas] and perfusion imaging). These codes combine the procedures described in 78579 (Pulmonary ventilation imaging [e.g., aerosol or gas]) and 78580 (Pulmonary perfusion imaging [e.g., particulate]). To report 78582, the physician must perform the imaging twice once after the patient inhaled a radioactive aerosol and another after the patient was injected with a radioactive particulate. 

In this diagnostic procedure, the provider performs both pulmonary ventilation and perfusion nuclear scan tests that evaluate the circulation of air and blood within the patient’s lungs. The aim is to perform quantitative analysis of differential pulmonary ventilation and perfusion in the lungs. This combined study is commonly performed to evaluate chronic obstructive pulmonary disease, pneumonia, bronchitis, or other infections.

If the physician has performed both the ventilation and perfusion using quantitative differential testing, you can report or 78598 (Quantitative differential pulmonary perfusion and ventilation [e.g., aerosol or gas], including imaging when performed). For reporting just the perfusion, you will report 78597 (Quantitative differential pulmonary perfusion, including imaging when performed). Codes 78582-78598 can be reported only once no matter how many projections are performed. In quantitative differential testing, the aim is to perform a quantitative analysis of differential pulmonary artery blood flow to rule out pulmonary stenosis. The provider can also perform this test with MRI or other radiologic imaging.