# Nuclear Stress Myoview



## MKurtz67 (Nov 16, 2007)

How would you recommend coding the following note: 
TWO -DAY PROTOCOL GATED SPECT EXERCISE MYOVIEW STUDY WITH WALL MOTION FIRST PASS STUDY 


TEST PROTOCOL: On 07/25/07 the patient was exercised on a motorized 
treadmill, beginning at Stage I of the Bruce protocol. The patient 
exercised for the totoal duration stated, achieving the maximum heart 
rate noted. The patient was injected with Technetium 99 Myoview 
during maximal treadmill exercise. SPECT imaging was begun 
immediately after exercise with recovery. Reconstruction of the SPECT 
tomograms was done using a quantitative analysis protocol. 

Myocardial perfusion study was performed and gated wall motion images 
were obtained during the stress in the vertical long-axis, horizontal 
long-axis, and short-axis views. 

On 07/26/07, first pass acquisition was obtained utilizing planar 
imaging with the injection of the rest dose of Myoview. First pass 
functional analysis was performed at rest with wall motion analysis. 
Heart counts were evaluated after appropriate phase imaging 
distributions. End-systolic and end-diastolic frames were then 
evaluated. 

On 07/26/07, baseline rest SPECT imaging was acquired one hour after 
Technetium 99 Myoview injection was given. These images were obtained 
using and SMV system. 

NOTE: All tests performed in the physician's office so billing is 
global. Stress test also performed (93015) and RPs billed for 
(A9502). The docs are initially coding this as a regular stress test: 
78465, 78478, 78480, plus the 93015 and A9502 as mentioned 
(documentation not included for brevity). The dication for the above 
is different than a regular "stress test" and I believe that the 
first pass may be coded as 78481 or 78483, but there may be some 
overlap in coding. Note there are CCI edits, but only for same DOS.

Thanks so much for your assistance.

Marti Troyer, CPC


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