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Coding for a ventilation and perfusion exam for pre-lung reduction surgery


In the below report the nuclear medicine department wants to bill for procedures defined by CPT® codes 78598 and 78835. I believe only the CPT code 78598 should be submitted. My understanding is that CPT code 78835 can “only” be billed with CPT codes 78830 or 78832 and no other nuclear medicine procedures. Is this correct?

The report reads as follows:

CLINICAL HISTORY: Hyperventilation; For lung volume reduction. Please do quantitative/ ventilation and perfusion
COMPARISON/CORRELATION: Chest CT of February 15, 2020
TECHNICAL/PROCEDURE INFORMATION: Planar images of the lungs were obtained in the routine projections for the ventilation and perfusion portions of the examination.
DOSAGE: 42.8 mCi of Tc-99m MDP loaded into a nebulizer with subsequent ventilation delivery of approximately 1 mCi radioaerosol to the lungs.
4.3 mCi Tc-99m low particle MAA preparation.
Differential lung perfusion is calculated as follows:
Left Lung: Upper Third: 15%, Middle Third: 29%, Lower Third: 21%
Total Left Lung: 65%
Right Lung: Upper Third: 6%, Middle Third: 21%, Lower Third: 8%
Total Right Lung: 35%
Differential lung ventilation is calculated as follows:
Left Lung: Upper Third: 16%, Middle Third: 31 %, Lower Third: 14%
Total Left Lung: 61%
Right Lung: Upper Third: 7%, Middle Third: 25 %, Lower Third: 7%
Total Right Lung: 39%
IMPRESSION: Differential perfusion and ventilation, as noted above.


This is defined by the single CPT code 75898. This code defines a quantitative ventilation and perfusion exam designed specifically for pre-lung reduction surgery. 

The code and full description are:

78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed

You are also correct that CPT code 78835 can only be reported with the two CPT codes 78830 and 78832.