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.
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.