Cardiology Coding Alert

Check differing hospital policies for who can report S&I If you're wondering whether to report modifier -26 for nuclear stress test supervision and interpretation, here's the answer you've been waiting for. The key to this modifier  -26 conundrum is in the location of the test, experts say: If it's performed at a hospital, you may have to dig deeper to comply with their differing policies. Read the Fine Print of Your Hospital's S&I Policies When your cardiologist performs this test in the hospital setting, you'll find that the diagnostic test supervision rules established by Medicare are not applicable. You may want to confirm the protocol at each of your hospitals.

Hospital policies vary widely regarding who provides supervision of these tests (doctors, nurses or nonphysician practitioners) and who can report it, says Bob Lloyd, CEO of Mid-State Cardiology in Nashville, Tenn.

Who Can Provide S&I: "In our community, only physicians are allowed to do this. We have two ARNPs (advanced registered nurse practitioners) that aren't allowed to supervise the treadmill test - but I do know other hospitals in nearby communities do allow NPs and PAs to do this," says Jennifer Kelchen, CCS-P, lead coder at Cardiologists PC in Cedar Rapids, Iowa.

Who Can Report S&I: "Our local hospital has a reading schedule and a call schedule for procedures such as EKGs, AVs, echoes, and nuclear studies. The physician who does the interpretation of the nuclear study will report the applicable codes, and the physician present during the stress portion will report 93016," says Joanna Anderson, CPC, billing manager and coder at Peninsula Cardiology Associates in Salisbury, Md.

The applicable myocardial perfusion study and the stress test codes for the physician who interprets the studies would be the one who reports:
 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
 +78478 - Myocardial perfusion study with wall motion, qualitative or quantitative study (list separately in addition to code for primary procedure)
 +78480 - Myocardial perfusion study with ejection fraction (list separately in addition to code for primary procedure)
 93016 - Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report
 93018 - Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only. FYI: You may already know that the cardiologist who supervises the treadmill portion of a hospital-based nuclear study should report 93016 and 93018, but did you know that you shouldn't apply modifier -26 (Professional component) to either of these codes? 

The reason is the descriptors of 93016 and [...]