CPT code and Description
78451: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
78452: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection
Allowed amount for CPT code 78451 AND 78452
| Insurance Company | Allowed Amount (CPT Code 78451) | Allowed Amount (CPT Code 78452) |
|---|---|---|
| Medicare | $1,200 | $1,500 |
| Medicaid | $800 | $1,000 |
| Blue Cross Blue Shield | $1,000 | $1,250 |
| Aetna | $1,100 | $1,350 |
| UnitedHealthcare | $1,050 | $1,275 |
| Humana | $950 | $1,175 |
| Cigna | $900 | $1,125 |
| WellPoint | $850 | $1,075 |
| Assurant | $800 | $1,000 |
Billing and Coding questions
Q – Which CPT codes should be used when describing MPI SPECT studies?
Myocardial perfusion imaging (MPI), through utilization of a gamma camera employing Single-Photon Emission Computed Tomography (SPECT) technology, has been viewed over the past decade as the gold standard for determining critical coronary artery stenosis. In addition, MPI represents roughly 95 percent of all cardiovascular procedures performed using nuclear imaging and has been identified by Medicare as a high-volume procedure. For these reasons, ASNC has compiled some common questions about the typical coding package that usually accompanies HCPCS Level I Current Procedural Terminology (CPT) codes 78451 and 78452 for MPI SPECT single and multiple studies, respectively
Q: The above example used 78452 to describe the imaging study. Can I use any of the CPT codes that describe MPI SPECT?
A: No! When deciding which code to use for any procedure, it is critical that coders select the name of the procedure or service that accurately identifies the service performed and not just choose a CPT code that merely approximates the service provided.
Q: Occasionally we are not able to gate a study and are not able to obtain a wall motion. If we do not perform wall motion does that mean we cannot bill CPT 78452?
A: No. The new parenthetical — (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed) — was structured to indicate that when wall motion and ejection fraction are performed, it would be considered to be inclusive in this newly bundled CPT code. However, if either is not performed, then it is still acceptable to use this code.
Q: Is it appropriate to bill the above cardiac stress test codes in conjunction with CPT 78452 since the code describes MPI SPECT studies performed at rest and/ or stress?
A: Stress testing is often used in conjunction with several nuclear cardiology procedures. CPT is clear in the cardiovascular introductory section (as noted below) for providers to code and bill separately for the stress test, in addition, to the nuclear cardiology procedure.
Billing Procedures that Span Multiple Days
During our meeting on March 30th, we presented how the acquisition of some imaging data, particularly in nuclear medicine, must span several days, which could be as long as 10 or more days following the initial injection of the radiopharmaceutical (RP). Examples of such a typical procedure are; 78452 MPI, SPECT, multiple study imaging, where the stress study is performed on day one and the resting study is conducted on day two; in this instance there are two separate RP (such as A9500 or A9502) study doses on separate days and one CPT procedure code CPT 78452. The RPs would be billed on the DOS when administered, however the CPT procedure code 78452 could be billed on day one, day two or the span of day one through day two. All three options would be correct and are used based on the varying billing systems in place at the facilities doing the procedures. Two other examples are tumor imaging studies (CPT codes ranging 78800-78804): an Octreotide study, where the injection is administered on day one (A9572) and imaging performed over the next 48 hours; and Prostascint studies where the injection (A9507) is given on day one and the scan occurs on day one and several days later.
Coding Guidelines and Examples:
CPT code 78451 is used for planar myocardial perfusion imaging, while CPT code 78452 is used for single-photon emission computed tomography (SPECT) myocardial perfusion imaging.
Proper documentation should include the reason for the test, relevant clinical history, and the interpretation and report of the study.
Examples of appropriate indications for MPI include evaluation of known or suspected coronary artery disease (CAD) and risk stratification of patients with established CAD.
Modifier Usage:
Modifiers may be used with these codes to provide additional information or indicate specific circumstances. Common modifiers used with CPT codes 78451 and 78452 include:
Modifier 26: This modifier indicates that only the professional component of the service was provided.
Modifier -TC: This modifier indicates that only the technical component of the service was provided.
Allowed ICDs (Diagnosis Codes):
For CPT codes 78451 and 78452, the allowed diagnosis codes (ICDs) will depend on the medical necessity and indications for the test. Common ICD codes associated with MPI include the below one and many more.
I25.10 – Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.118 – Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
Bundled Codes with Other CPTs:
CPT codes 78451 and 78452 are commonly associated with other codes that represent additional components or procedures. Some examples of bundled codes include:
CPT code 93015 – Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress
CPT code 93016 – Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision
Different Denial Reasons:
Denial reasons for CPT codes 78451 and 78452 can vary depending on factors such as medical necessity, documentation, and compliance with Medicare guidelines. Common denial reasons include:
Lack of medical necessity: Insufficient documentation to support the medical necessity of the test.
Coding errors: Incorrect use of modifiers, incomplete submission of required information, or mismatch between the diagnosis codes and the indications for the test.
Frequency limitations: Medicare may impose limitations on the frequency of MPI tests, and claims exceeding these limits may be denied.
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