Download (MUGA) scanning

National Imaging Associates, Inc.
Clinical guidelines
MUGA (Multiple Gated Acquisition) Scan
CPT Codes: 78472, 78473, 78494, +78496
Guideline Number: NIA_CG_027
Responsible Department:
Clinical Operations
Original Date:
Page 1 of 4
Last Review Date:
Last Revised Date:
Implementation Date:
September 1997
August 2016
August 2016
January 2017
INTRODUCTION:
Multiple-gated acquisition (MUGA) scanning is a radionuclide ventriculography technique
to evaluate the pumping function of the ventricles of the heart. During this noninvasive
nuclear test, radioactive tracer is injected into a vein and a gamma camera detects the
radiation released by the tracer, providing moving images of the heart. From these images,
the health of the heart’s pumping chamber, the left ventricle, can be assessed. It is used to
evaluate the left ventricular ejection fraction (LVEF), a measure of overall cardiac function.
It may also detect areas of poor contractility following an ischemic episode and it is used to
evaluate left ventricular hypertrophy.
Initial Clinical Reviewers (ICRs) and Physician Clinical Reviewers (PCRs) must be able to
apply criteria based on individual needs and based on an assessment of the local delivery
system.
INDICATIONS FOR MULTIPLE-GATED ACQUISITION (MUGA) SCAN:
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To evaluate left ventricular (LV) function at baseline before chemotherapy or cardiotoxic
therapy; may be repeated prior to subsequent chemotherapy cycles until a total
cardiotoxic dose has been reached.
To evaluate ejection fraction in a patient with congestive heart failure (CHF), when
prior cardiac imaging has proven inadequate for an accurate determination of ejection
fraction.
To evaluate patient, who is obese or who has chronic obstructive pulmonary disease
(COPD), for coronary artery disease (CAD).
As an alternative form of stress imaging instead of echocardiography or myocardial
perfusion imaging, based upon similar necessity criteria for the evaluation of coronary
or valvular heart disease.
COMBINATION OF STUDIES WITH MUGA:
Abdomen CT/Pelvis CT/Chest CT/Neck MRI/Neck CT with MUGA – known tumor/cancer
for initial staging or evaluation before starting chemotherapy or radiation treatment.
ADDITIONAL INFORMATION RELATED TO MUGA:
Request for a follow-up study - A follow-up study may be needed to help evaluate a patient’s
progress after treatment, procedure, intervention or surgery. Documentation requires a
medical reason that clearly indicates why additional imaging is needed for the type and
area(s) requested.
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MUGA Scan Monitoring during Chemotherapy – Chemotherapeutic drugs that are used in
cancer treatment may be toxic to the heart muscle. To minimize the risk of damaging the
heart muscle with these drugs, the patient’s cardiac function may be monitored with the
MUGA scan before and during administration of the drug. Before the first dose of the drug,
a MUGA scan may be performed to establish a baseline left ventricle ejection fraction
(LVEF). It may then be repeated after cumulative doses. If the LVEF begins to decrease,
cardio toxicity risk must be considered if continuing the treatment.
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