You Be the Coder:
Billing for Staged Studies
Published on Sat Dec 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Often, our nuclear radiologists perform myocardial perfusion imaging studies that span more than one calendar day. For instance, they might conduct the study with the patients at rest one day, and bring them back the next day for a stress test. May we bill for two studies when this occurs?
Maryland Subscriber
Codes 78460 and 78464 describe uniphase studies (either rest or stress, but not both) that are conducted during one session, while 78461 and 78465 represent multiphase studies (both rest and stress) occurring over several hours or even multiple days. Coders should also recognize that this series includes two discrete sets of codes 78460 and 78461 are planar studies, while 78464 and 78465 are three-dimensional or tomographic. Practices may report wall-motion and ejection-fraction studies in addition to myocardial perfusion imaging when performed and documented. Wall-motion tests measure the movement of the left ventricle from systole to diastole, which is identified as normal, akinetic, dyskinetic or hypokinetic. Coders would report 78478 (myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) when this procedure is performed. Ejection fraction, on the other hand, refers to the volume of blood being pumped out of the heart usually via the left ventricle. A sophisticated computer program is used to calculate this measurement, which is reported as a percentage. The appropriate code to assign to this procedure is 78480 (myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]). Answer: No, you would not bill the study twice. Medicare and other payers consider this unbundling.
Myocardial perfusion imaging exams are performed to assess the condition of patients with known or suspected coronary artery blockage. During the study, radiopharmaceuticals like thallium and some technetium-99m compounds are introduced intravenously, and blood flow to the heart is measured. The exams are described in four specific CPT Codes :
Codes 78460 and 78464 describe uniphase studies (either rest or stress, but not both) that are conducted during one session, while 78461 and 78465 represent multiphase studies (both rest and stress) occurring over several hours or even multiple days. Coders should also recognize that this series includes two discrete sets of codes 78460 and 78461 are planar studies, while 78464 and 78465 are three-dimensional or tomographic. Practices may report wall-motion and ejection-fraction studies in addition to myocardial perfusion imaging when performed and documented. Wall-motion tests measure the movement of the left ventricle from systole to diastole, which is identified as normal, akinetic, dyskinetic [...]
