Cardiology Coding Alert

More and more cardiology practices are using nuclear stress tests to assess myocardial function, which means that coders must understand how to report resting and stress gated studies. To code these tests accurately, you'll need to be able to answer the following five crucial questions. 1. What is the type and quantity of the radioisotope injected? Prior to a nuclear scan (often referred to as a SPECT[single-photon emission computed tomography] scan), a patient receives an injection of one of three radioisotopes: technetium 99m sestamibi, technetium 99m tetrofosmin, or thallous chloride. Most insurance carriers, including Medicare, require information on which radioisotope the patient received and the quantity of the material injected. Report the radioisotope using the appropriate HCPCS codes:
A9500 Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose; also known as Cardiolite.
A9502 technetium Tc 99m tetrofosmin, per unit dose; also known as Myoview.
A9505 thallous chloride TL-201, per millicurie. For example, patients typically receive 10 millicuries of sestamibi during the rest portion of the study and 30 millicuries during the stress portion, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C. In such cases, you would bill A9500 x 2 to indicate sestamibi injection for both rest and stress. Be aware that some private insurance companies are still not familiar with these supply codes and either bundle them with the procedure or substitute unlisted-procedure codes such as 78999 (Unlisted miscellaneous procedure, diagnostic nuclear medicine) and 79999 (Unlisted radiopharmaceutical therapeutic procedure), says Janet White, RN, CPC, CMM, practice manager for a cardiovascular outpatient facility in Seneca, S.C., and president of the South Carolina Medical Office Managers group.

Private carriers may require 78990 (Provision of diagnostic radiopharmaceutical[s]) in place of the HCPCS codes Medicare requires. Supplies reported using this code are not measured in doses, so the specific amount used should be entered in the claim form's message line (paper or electronic). The IVplacement for radioisotope administration is included in the scan and should not be reported separately. Sometimes, the amount reimbursed for sestamibi or one of the other radioisotopes is less than the amount the practice spent to purchase the drug, White says. Educating payers about such matters as the advantages of using sestamibi versus thallium, for instance, could help reduce reimbursement reductions. For instance, you could explain that sestamibi, although more expensive than thallium, has a shorter half-life and has superior radiation dosimetry compared to thallium. 2. What is the type and dosage of the stressing agent? After rest imaging, patients will undergo stress imaging. Patients exercise on a treadmill or a stationary bicycle while being continuously monitored by an electrocardiogram (EKG) or receive pharmacologic stress agents to induce [...]