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(CPT 78465), "Myocardial perfusion imaging, tomographic (SPECT), multiple studies, at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest ejection, with or without quantification.We checked the Medicare Correct Coding Initiative ("CCI) Bundling Rule for comparison to determine if this was a proper denial of this CPT code. The CCI updates from the third quarter of 2001 through the third quarter of 2002 do not list CPT 78480 as a component of 78465. As many health plans have begun using Medicare as a basis for determining bundling rules, these disallows for the CPT code 78480 should be challenged with the argument that the health plan's edits do not conform to CPT or CMS standards. The request for reconsideration should also include a request for both the plans' policy and their rationale on payment of such myocardial imaging services.
- Aetna has disallowed CPT code 78480. This CPT code is an add-on code described in the 2002 CPT book as:
"Myocardial perfusion study with ejection fraction (list separately in addition for the code for the primary procedures)".
- In parenthesis below the code it specifically states:
"Use 78480 in conjunction with codes 78460, 78461, 78464, 78465"
Karen M. Beard, CPC (bio...)
Senior Associate
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