# Question on the Myocardial Perfusion Study



## tmr1965 (Feb 8, 2018)

I am just now learning the Nuclear Stress Test, so for this do you only code the 93016 & 93018 with the 78452-26 when the patient is using the treadmill, and it's done in the hospital setting?


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## cpc2007 (Feb 10, 2018)

*Myocardial Perfusion Study*

Good morning, 

A stress test and a myocardial perfusion study are two different tests but can be performed at the same time for some patients.  The stress test measures the effect of stress on the heart by looking at a patient's EKG and checking their heart rate, blood pressure, and breathing while they are resting before the test and then looking to see if there are changes as the test progresses. They can measure how stress affects the heart either by having the patient exercise on a bike or a treadmill (sounds like that's how they performed the test in your case) or by giving the patient medication that makes their heart mimic what it would do if they were exercising for patients who can't do the treadmill stress test (e.g., someone with joint problems who can't exercise on a treadmill). The myocardial perfusion study involves injecting a nuclear isotope/tracer and then taking images to show how well blood is flowing to the heart. 

To code a treadmill stress test performed at the hospital, you can code both 93016 and 93018 as you suggested if your doctor is providing the direct supervision for the test (the 93016) and interpreting the test results (the 93018). Direct supervision means that the doctor is present at the hospital and immediately available to assist should the patient need his care during the stress test.  If someone other than your physician provides the direct supervision for the test and your physician is interpreting the test results only, then only 93018 should be coded.  

To code the myocardial perfusion study, you would code 78452.26 as you suggested if they perform and interpret multiple studies (such as imaging the heart while the patient is resting and then when he is at stress on the treadmill), and you would code 78451.26 instead if they only do one set of images (at rest or stress but not both).  The 78452.26 is more common in my experience, and I generally look for the physician to compare his two sets of images (e.g., the heart was well perfused at baseline; at maximum stress there was decreased flow but no evidence of severe ischemia). That lets me know that multiple studies were performed. 

I hope that helps


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## KoBee (Apr 24, 2019)

so if you have another provider signing off the Nuclear Medicine Myocardial Perfusion Scan, then the cardiologist will not get credit for 78452, correct?


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## shawnab27 (Jun 21, 2019)

for hospital we use 78452-26 and 93018 no modifier


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## cpc2007 (Jun 22, 2019)

michiboo said:


> so if you have another provider signing off the Nuclear Medicine Myocardial Perfusion Scan, then the cardiologist will not get credit for 78452, correct?


Yes that's correct. Sometimes another physician/specialty department (e.g., nuclear medicine) will interpret the myocardial perfusion scan. In that case, the cardiologist would report only the stress test and the second physician would report the interpretation of the myocardial perfusion. 

Kim
www.codingmastery.com


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