# contrast injection



## macrossley (Nov 12, 2009)

is there a procedure code i can use to bill for the injection of the contrast agent A9500 used in the myocardio perfussion studies? this is administered via IV. or is it being bundled into the test itself?


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## jgf-CPC (Nov 12, 2009)

Myocardial Perfusion Studies with Thallium 

There may be four separate codes required to obtain reimbursement and track utilization correctly for myocardial perfusion and cardiac blood pool imaging studies; these codes along with the appropriate line item data are to be entered on the CMS –1500 or UBClaim Form.

1.       Selection of HCPCS code for the radiopharmaceutical/imaging agent
2.       Selection of CPT codes for the myocardial perfusion procedure(s), any add-on procedures, and stress testing
3.       Selection of HCPCS code for any pharmaceutical stress agent, and injection/infusion administration 
4.       ICD-9-CM diagnosis codes and documentation of medical necessity

1.           Selection of HCPCS code for the radiopharmaceutical/imaging agent


HCPCS Code	Description
A9505	Supply of radiopharmaceutical imaging agent, thallous chloride TL-201, diagnostic, per mCi

When billing Thallium make sure you round the dose up to the next whole number - if you inject 3.5mCi bill 4 units of A9505

2.     Selection of CPT codes for the myocardial perfusion procedure(s), plus add-on procedures and stress testing, as appropriate

As noted in American Medical Association, CPT-4 2007, myocardial perfusion and cardiac blood pool imaging studies may be performed at rest and/or during stress. The table below lists the appropriate procedure codes. When performed during exercise and/or pharmacologic stress, the appropriate stress test code from the 93015-93018 series should be reported in addition to these procedure codes.

CPT Code	Description
78460	Myocardial perfusion imaging; (planar) single study at rest or stress (exercise and/or pharmacologic), with or without quantification
78461	Myocardial perfusion imaging; multiple studies, (planar) at rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification
78464	Myocardial perfusion imaging; tomographic (SPECT), single study at rest or stress (exercise and/or pharmacologic) with or without quantification
78465	Myocardial perfusion imaging; tomographic (SPECT), multiple studies, at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification
78472	Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing
78473	Cardiac pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification
78481	Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification
78483	Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification
78494	Cardiovascular blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing

Add –on Procedure codes

CPT Code 	Description
78478	Myocardial perfusion study with wall motion, qualitative or quantitative study (list separately in addition to code for primary procedure) (Use 78480 in conjunction with codes 78460, 78461, 78464,78465)
78480	Myocardial perfusion study with ejection fraction (list separately in addition to code for primary procedure) (Use code 78481 in conjunction with codes 78460,78461,78464, 78465)
78496	Cardiac blood pool imaging, gated equilibrium, single study, at rest with right ventricular ejection fraction by first pass technique (list separately in addition to code for primary procedure) (Use 78496 in conjunction with code 78472)

Cardiovascular Stress Test, when performed

CPT Code	Description
93015	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)
93016	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision only, without interpretation and report (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)
93017	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)
93018	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)

3.           Selection of HCPCS/CPT codes for any pharmaceutical stress agent


HCPCS Code	Description
J0152	Injection, adenosine, 30 mg
J1250	Injection, dobutamine HCI, per 250 mg (Dobutrex)
J1245	Injection, dipyridamole, per 10 mg (Persantine IV)


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