Myocardial PET – Get Ready to Reset

Background

Possibly the single largest exam performed in nuclear medicine is the myocardial perfusion exam. This study provides differentiation between ischemic and infarcted cardiac tissue.

  • Infarcted tissue (otherwise referred to as myocardial infarction, or MI) describes cardiac tissue that is dead–this tissue is not currently being supplied by blood.
  • Ischemic tissue describes tissue that is not supplied by blood currently, but blood does make its way into the tissue at a later time.

These studies can help determine the extent of disease and inform treatment decisions while offering management options for patients.

Myocardial PET is a specific type of imaging which has been gaining traction as a recommended and preferred method of non-invasive cardiac imaging by providers and societies. Why is this exam gaining traction? The reason is due to its high level of accuracy when diagnosing and managing patients with known or suspected coronary artery disease.

Coding and Billing Confusion

Unfortunately, cardiac PET is subject to coverage limitations (from a Medicare perspective) and is one of the most frequently questioned areas when it comes to coding and billing for services:

  • What’s billable? What’s covered and what isn’t? What diagnosis codes are covered for billing myocardial PET? What are the medical necessity requirements? What can be charged together and what can’t? How do you bill cardiac PET for sarcoidosis? How do you, and can you, charge for quantification of blood flow, wall motion and ejection fraction? What about cardiac PET/CT?

These are some of the areas that have caused consistent coding and billing problems across the country–and in six months it will be time to forget everything we currently know about coding and billing for myocardial PET.

Get Ready to Reset

Going into effect January 1, 2020, the current CPT® codes for myocardial PET (78459, 78491, 78492) are undergoing description revisions and there will be an additional six new CPT codes introduced to separately identify component services of cardiac PET. Additionally, add-on code 0482T (absolute quantification of myocardial blood flow) will be deleted, presumably to be included in one of the new cardiac PET codes being released.

The unknowns: What the revisions to the existing codes will be, what the new codes will be, what the new descriptions will entail, what the guidelines for use will look like or if there will be any coverage updates.

The confirmed truth: These changes are going to have a significant impact on anyone responsible for coding and billing functions for myocardial PET.

Be prepared: Mark your calendars and keep an eye out for the latest news coming out of the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA) and specialty societies. Expect more information to be released as we move toward 2020.

Stay tuned.

Two Easy Ways to Stay Informed

  1. Radiology (and nuclear medicine) specific coding and compliance news delivered to you monthly in our Radiology Compliance Manager newsletter. Let us cut through the clutter and deliver to you a monthly review of news, risk areas and potential compliance issues specific to imaging services.
  2. Pre-order the 2020 edition of the Nuclear Medicine & PET Coder. Based on their experiences with hospitals and physician practices nationwide, our experts have identified many areas of confusion, uncertainty and noncompliance. This resource was designed to specifically respond to real-world coding, documentation and billing issues faced in nuclear medicine with workable solutions, distilled into clear-cut instruction, tips and case examples.
Facebook
Twitter
LinkedIn

Bryan Nordley

Bryan Nordley is a seasoned professional writer, strategist, and researcher with over a decade’s worth of combined experience. Bryan launched his professional health writing career at the University of British Columbia’s Faculty of Medicine, one of the top 30 faculty of medicine programs in the world, working under the School of Public Health as a communications assistant. From there, he expanded his expertise and knowledge into private healthcare and podiatry before taking the role of healthcare writer at MedLearn Media. Bryan is the lead writer for the MedLearn Publishing brand previously producing both the acclaimed radiology and laboratory compliance manager newsletter products, while currently writing the compliance questions of the week which reach over 10,000 subscribers, creating the MedLearn Publishing Insights blogs and collaborating with operations and nationally renowned subject matter experts, in addition to serving as an editor for a variety of MedLearn publications along with marketing initiatives. Bryan continues to keep his pulse on the latest healthcare industry news, analyzing and reporting with strategic insight.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24