Radiology Question for the Week of September 5, 2016

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:

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. In the event a patient receives a SPECT test with inconclusive results, a PET scan may be covered. However, if a patient receives a FDG PET study with inconclusive results, a follow up SPECT test is not covered.

If a SPECT study was performed but inconclusive, documentation must be provided to support the additional performance and billing of the PET scan.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.