# E&M Visit 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?


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## cfuficat (Feb 14, 2008)

*Nuclear Stress Testing*

I don't code an EM visit with the stress test.  The physician performing the stress test will usually list the chief complaint and any prior diagnosis pertinent to the stress test (ie..CAD, HTN, HC).  I also assumed it's included in the stress test portion.  The CPT coding guidelines under Nuclear Medicine state "If the physcian providing nuclear medicine services is also responsible for the diagnostic work-up and/or follow-up care, evaluation and managment service codes should be coded in addition to nuclear medicine procedures."  Coding an EM visit simply because the patient is new doesn't sound right.  I'll see what else I can find....

As far as coding a consult, I normally see the consult for cardiology 1st than the stress test follows????  I guess if they were done on the same day you can code both as long as a consult was requested by the PCP.


Thanks


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## kevbshields (Feb 16, 2008)

The situation you describe sounds very much like that of a Gastroenterologist performing a brief physical exam & history prior to scopes.  Under the practice standards of their professional association, it recommends they perform such evaluations in order to substantiate that the patient is fit enough for the procedure.  Such exams are not, in most cases, separately reportable.

I believe this situation would fall into that same category.  However, I think it wise to refrain from making blanket statements that "it can never be reported" or something similar.  I have seen instances where a formal consult was requested and the consulting provider decided _that day_ to request a stress for his/her own diagnostic evaluation.  

To be short, if you can verify that the patient meets medical necessity for both a stress and a separate and distinct E/M service, both may be reported.  

Here's a safe bet, visit www.asnc.org (American Society of Nuclear Cargiologists) and pull up the Practice Guidelines/Standards documents.  I, for some reason, cannot pull up the pdf files this morning.  Those documents should help you establish a "protocol" with your providers in determining when it is and is not appropriate to assign both service codes and help you to better understand the examination requirements prior to performing the study.

Good luck.


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## JBurnham (Feb 19, 2008)

Thank you for your help.


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