# Nuclear Stress Test-Help



## peeya (Sep 8, 2010)

I am a little confused. I work for a cardiologist. They do Nuclear Adeno Stress test in the Hospital. Can you please confirm what are the codes that I should be billing. Is it :

93018
93016
78452-26

or

93018
93016
93350-26


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## Jess1125 (Sep 9, 2010)

Top group of codes.

The below group would be a stress echo done in the hospital.

Jessica CPC, CCC


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## peeya (Sep 9, 2010)

Just to confirm, I should bill 93018 93016 & 78452-26 for Nuclear Stress done in the hospitals but how about if the Doctor is dictating only the stress potion of the test. the rest is done by the NP.


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## Jess1125 (Sep 10, 2010)

Yes 93016, 93018, 78452-26 for nuclear stress test.

In your second question are you saying that the physician just dictated on the stress test and the NP monitored?
That would be 93018 then for the physician and the NP would be billing 93016. 

Jessica CPC, CCC


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## barbiehays (Nov 23, 2010)

*NP versus Physicain supervision*

Just wanted to clarify-

The NP supervises the stress portion of the test.  93016 states *physician supervision.  Is it okay for the NP/PA to bill for 93016?

The physician then interprets the test, so bill 93018.  

-Barbie*


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## cookc (Dec 7, 2010)

*Can someone help me with Stress Echo coding*

I need to know what codes are appropriate for a hospital to charge when doing a exercise stress echo and what codes for a Dobutamine stress echo?  
Thank


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## peeya (Dec 7, 2010)

I am confused. I was told that for Nuclear Adeno Stress test done in the Hospital the CPT code would be 93018 93016 &  93350-26  if the Doctor is their only for the stress portion of the test. If he is there for the full test then we can bill 93018, 93016  78452-26

As for the regular Stress Test done in the Hospital the CPT codes are 93018 & 93016 only.

Please confirm.


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## Jess1125 (Dec 8, 2010)

I'm confused myself. 

93016/93018/93350-26 is for a stress ECHO

93016/93018/78452-26 is for a nuclear stress test done in the hospital.

I would code the 93016/93018/78452-26 for a nuclear stress test done in the hospital.

Jessica CPC, CCC


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## peeya (Dec 9, 2010)

Jess1125 said:


> I'm confused myself.
> 
> 93016/93018/93350-26 is for a stress ECHO
> 
> ...



If i bill 93016/93018/78452-26 then what will the NP bill who was there for the resting portion of the nuclear stress test?


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## Jess1125 (Dec 9, 2010)

I have no idea. I've never heard of one provider being there for the stress portion and another being there for the rest portion. 

Is the same provider interpreting BOTH resting/stress images, though? 

Its a study you're saying is done in the hospital. You'd only be billing for the interpretation and I'd imagine it is the MD who is interpreting all the images.

Anybody else? 

Jessica CPC, CCC


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## peeya (Dec 9, 2010)

ADENOSINE MYOCARDIAL PERFUSION STUDY
CLINICAL INDICATION: 53-year-old patient with chest pain.
TECHNIQUE: Adenosine 104 mg intravenously dual isotope separate acquisition
gated myocardial perfusion SPECT using Tc 99m Sestamibi 42.8 mCi
intravenously at stress and Thallium 201 4.0 mCi intravenously at rest was
performed using the rest/stress sequences at stress. The SPECT images were
obtained in the supine position only.
FINDINGS: Perfusion images reveal no definite evidence of perfusion
defects.
Adenosine post stress gated SPECT images show no wall motion abnormalities.
IMPRESSION:
1. NO EVIDENCE OF PERFUSION DEFECTS OR WALL MOTION ABNORMALITIES.
2. THE LEFT VENTRICLE EJECTION FRACTION AT STRESS IS 70%.
A CALL REPORT WAS MADE TO DOCTOR AND A MESSAGE WITH THE RESULTS
WAS LEFT ON 10/25/2010 11:40 AM.

*The above mentioned report was dictated by the NP for the adeno done in the hospital*.


*The below mentioned report was by the Doctor*


CLINICAL INDICATION: Preoperative risk assessment hypertension,
hyperlipoproteinemia, EKG abnormalities.
PROCEDURE: Patient was attached to continuous EKG and blood pressure
monitoring. Subsequently, a total of 104 mg of adenosine was infused
over 5 minutes. This was followed by SPECT nuclear imaging.
CLINICAL INFORMATION: Resting heart rate is 71, peak heart rate 83
beats per minute.
Resting blood pressure 127/74, peak blood pressure 154/67.
CLINICAL SYMPTOMS: None.
RESTING ELECTROCARDIOGRAM: Sinus rhythm, nonspecific ST-T changes,
right bundle branch block.
STRESS ELECTROCARDIOGRAM: No changes.
SUMMARY: Clinical: Nonischemic.

_*Now if someone can tell me how would the test be billed. If I bill the 93016, 93018 & 78452-26 then what will the NP bill for her portion? *_


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