# E&M same day as Nuclear Stress Test



## JBurnham (Feb 14, 2008)

We perform Nuclear Stress Testing in our office.  Our physicians have recently been told by a colleague that if the patient being referred to them is new to the practice and they perform a brief consult or history and physical, they can also bill this in addition to the test. 

I have always been under the impression that the "brief H&P" would already be included with part of the test and you would not bill this separately.  

I have been able to find no guidelines on this.  The only reasoning I can find for them to do this is if the referring doctor specifically requests for the doctor to also do a consult in addition to the test.  Otherwise, I cannot see billing an E&M with this.

Does anyone currently do this or have you heard of doing this?


----------



## cfuficat (Feb 28, 2008)

*Stress Test w/ EM*

I also code stress tests but do not code an EM visit.  Normally, the chief complaint is documented and a brief history which would be included in the test.  I cannot find any specific guidlines on this either.

The patient being referred for the stress test already has some type of sign or symptom or established diagnosis.  I do not see why it would be necessary for the physician to do their own E/M if it was not requested in a consult.  

The only thing I could find in the CPT book is "If the physician provding nuclear medicine services is also responsible for the diagnositic work-up and/or follow-up care of the patient, E/M service codes should be coded in addition to the nuclear medicine procedures."  I can see if the patients primary care requests a cardiology consult and the cardiologist decides to order/perform the stress test the same day but otherwise I don't think an E/M visit should be coded just because the patient is new.

Thanks,

Christy


----------

