Nuclear Medicine Question for the Week of October 24, 2016

Question:

Question:

Do you have any coding guidelines for reporting 78451 (myocardial perfusion scan/SPECT) and 78459 (myocardial PET for viability) together? According to a RAC audit, both cannot be billed.

Answer:

Answer:

According to the Medicare national coverage determination for FDG PET for myocardial viability (78459), Medicare covers 78459 as a primary or initial diagnostic study prior to revascularization or following an inconclusive SPECT. Therefore, in the event a patient first receives a SPECT test with inconclusive results, a PET scan may be covered. However, if a patient first receives a FDG PET study with inconclusive results, a follow up SPECT test is not covered.

Please note that, in the event a patient first receives a SPECT study and it was inconclusive, documentation must be provided to support the additional performance and billing of the PET scan.