Oct-Nov 00 Part A Bulletin - Medicare

LOCAL AND FOCUSED MEDICAL REVIEW POLICIES
78472: Cardiac Blood Pool Imaging (continued)
Noncovered ICD-9-CM Code(s)
Any diagnosis codes not listed in the “ICD-9-CM
Codes That Support Medical Necessity” section of this
policy.
Noncovered Diagnosis
N/A
Coding Guidelines
Procedure code 78496 (cardiac blood pool imaging,
gated equilibrium, single study, at rest, with right ventricular
ejection fraction by first pass technique) is considered an
add-on code, and therefore, should only be billed in
conjunction with procedure code 78472 (cardiac blood pool
imaging, gated equilibrium; planar, single study at rest or
stress, wall motion plus ejection fraction, with or without
additional quantitative processing).
In certain indications, it is common for a patient to
undergo a myocardial perfusion imaging study (78460-
78465, 78478-78480) and a cardiac blood pool imaging
study during the same session. However, it is not expected
that two different techniques (e.g., 78478 and 78472) be
billed since the information such as wall motion and/or
ejection fraction is obtained from the cardiac blood pool
imaging technique. In this type of scenario, the billing of
the lesser code is considered a duplicate of the cardiac
blood pool imaging code.
It is not expected for a provider to bill for the multiple
study procedure codes (78473 and 78483) on the same day,
since the multiple study is performed using either the gated
equilibrium method or the first pass technique.
Effective for services on or after 10/01/2000, diagnosis
code V58.83 should be used when the imaging is being
performed for the evaluation and management of a patient
with a neoplastic disease who will be or is receiving an
anthracycline like neoplastic drug. The E codes (E930.7 or
E933.1) should be used when the patient is experiencing
adverse events to the anthracycline like neoplastic drug.
Documentation Requirements
Medical record documentation maintained by the
ordering/referring physician must clearly indicate the
medical necessity of cardiac blood pool imaging studies. In
addition, the results of the study must be included in the
patient’s medical record. This information is normally
found in the office/progress notes, hospital records, and/or
test results.
If the provider of the service is other than the ordering/
referring physician, that provider must maintain hard copy
documentation of test results and interpretation, along with
copies of the ordering/referring physician’s order for the
studies. The physician must state the clinical indication/
medical necessity for the service in his order for the test.
Utilization Guidelines
N/A
Other Comments
N/A
Sources of Information
Braunwald, E. (Ed.). (1992). Heart disease: A textbook of
cardiovascular medicine (4th ed.). Philadelphia: W. B.
Saunders.
Gerson, M. C. (Ed.). (1997). Cardiac nuclear medicine
(3rd ed.). New York: McGraw-Hill.
Iskandrian, A. S., & Verani, M. S. (1996). Nuclear
cardiac imaging: Principles and applications (2nd ed.).
Philadelphia: F. A. Davis Company.
Schlant, R. C. & Alexander, R. W. (Eds.). (1994). The
heart (8th ed.). New York: McGraw-Hill.
Willerson, J. R. & Cohn, J. N. (Eds.). (1995).
Cardiovascular medicine, New York: Churchill
Livingstone.
Advisory Committee Notes
This policy does not reflect the sole opinion of the
contractor or Contractor Medical Director. Although the
final decision rests with the contractor, this policy was
developed in cooperation with the contractor’s Advisory
Committee, which includes representatives from the Florida
Chapter of the American College of Cardiology.
Start Date of Comment Period
N/A
Start Date of Notice Period
10/01/2000
Revision History
Revision Number: 2
Start Date of Comment Period: N/A
Start Date of Notice Period: 10/01/2000
Oct/Nov 2000 Bulletin
Revised Effective Date: 10/01/2000
Explanation of Revision: Numerous inquires have been
received regarding the
appropriate diagnosis to bill prior
to beginning anthracycline like
neoplastic drugs. A policy
revision was needed to address
this issue. Annual ICD-9-CM
Update
Revision Number: 1
Start Date of Comment Period: N/A
Start Date of Notice Period: 02/25/2000
Special Issue 2000
Revised Effective Date: 08/01/2000
Explanation of Revision: Outpatient PPS
implementation.
Start Date of Comment Period: 11/15/99
Start Date of Notice Period: 02/2000
Feb/Mar 2000 Bulletin
Original Effective Date: 03/15/2000 �
24 The Florida Medicare A Bulletin
October/November 2000