Three types of studies considered for myocardial perfusion billing are rest, stress, and redistribution

Q.

Myocardial perfusion scan CPT^® code 78452 includes multiple studies. Are they required to be at rest and stress? What about prone studies? 

A.

The three types of studies considered for myocardial perfusion billing are rest, stress, and redistribution. The code descriptor states “multiple studies” indicating that more than one should be performed to report these codes. However, the code uses language “and/or” to indicate that it can be at rest and stress, or either rest or stress and/or redistribution, and/or rest injection. Prone is not considered a separate study when coding myocardial perfusion scans 78452 or 78454. Prone is considered an additional image, not study. The codes and full descriptions are as follows:

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

78454 Myocardial perfusion imaging, planar (including 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