Possibly the single largest exam performed in nuclear medicine is the myocardial perfusion exam. This study provides differentiation between ischemic and infarcted cardiac tissue.
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:
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
Radiology reports are rich with clinical detail—abnormalities, precise anatomy, and incidental findings—but that level of detail doesn’t always translate cleanly into ICD-10 coding. In my
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