Radiology Coding Alert

Coding cardiovascular studies for nuclear medicine need not cause despair if you can tell an MPI study from a blood pool analysis. In a recent teleconference presented by the Coding Institute titled "Strategies for Optimum Nuclear Medicine Coding and Reimbursement," Melody W. Mulaik, MSHS, CPC, RCC, president and co-founder of Coding Strategies Inc. in Atlanta, presented a series of questions that will make nuclear medicine coding easier.

Of the five main types of cardiovascular studies myocardial perfusion imaging (MPI), gated cardiac blood pool imaging, first pass cardiac imaging, myocardial infarction imaging, and right-to-left shunt evaluation the first two are by far the most common. The Many Faces of Myocardial Perfusion Imaging According to Mulaik, coders often express frustration at the difficulty of differentiating between perfusion and blood pool studies. Perfusion imaging involves analysis of the regional flow of blood and radionuclide within the heart muscle itself, while blood pool studies evaluate the heart's structural cavity.

MPI presents four codes to choose from: 78460 (Myocardial perfusion imaging; [planar] single study, at rest or stress [exercise and/or pharmacologic], with or without quantification); 78461 (... multiple studies, [planar] ...); 78464 (... tomographic [SPECT], single study at rest or stress [exercise and/or pharmacologic], with or without quantification); and 78465 (... tomographic [SPECT], multiple studies ...). Planar imaging, nuclear medicine's most basic image, is the simplest technique, but SPECT, which is a multiplanar study, is the more common. Most often, Mulaik says, "you're going to see a SPECT study at rest and stress. 78465 is by far the most popular code that's used with MPI. But it's important to make sure that the documentation supports it." Add-On Codes Add-on codes are a key element to obtaining correct reimbursement for cardiovascular nuclear studies. Wall motion studies (+78478, Myocardial perfusion study with wall motion, qualitative or quantitative study) document the actual wall motion of the heart by tracking the movement of the left ventricle from systole to diastole. This add-on code may only be assigned with perfusion imaging CPT Codes 78460, 78461, 78464 and 78465.

Mulaik says you may sometimes see a wall motion study called by alternative language referring akenesis, dyskenesis or hypokenesis. She instructs coders to list wall motion in addition to the code for the primary procedure. For complete reimbursement, wall motion requires clear documentation from the physician. The ejection fraction (+78480, Myocardial perfusion study with ejection fraction), which calculates how much blood the heart is pumping out to the rest of the body, always shows up in a patient chart as a percentage. Sometimes the doctor will just say it was normal, but ideally he will state the exact percentage in the radiology [...]