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.