Cardiology Coding Alert

Question: I’m getting back into coding stress tests again after not coding them for about 12 years. Can you give me a basic summary of current coding for nuclear tests so I know where to start?

Indiana Subscriber

Answer: MPI: For the myocardial perfusion imaging, choose from 78451-78454. These codes include qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, and any additional quantification, when performed. The codes break down like this:

If you’re reporting only the physician’s services, be sure to append modifier 26 (Professional component) to the nuclear medicine code.

Stress test (+ echo): Your coding for the stress portion of the study will depend on the exact services your provider is responsible for. For example, for a complete stress test, use 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report). But if you’re reporting only a component of the stress test, choose from 93016- 93018.

Note that if you’re reporting a complete stress echo, then you should use 93351 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional). Do not additionally report a code from 93015-93018.

But if you’re reporting a component code (93016-93018), then you should add echo code 93350 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report) for the echo.

Radioisotopes: If your practice supplies the radioisotopes, you should report the appropriate HCPCS code based on the supply and dosage. For example if the patient received sestamibi you would report A9500 (Technetium Tc-99m sestamibi, diagnostic, per study dose) once per study.

Stress agent: If the patient requires a stressing agent and your practice provides it, again, you should report the appropriate HCPCS code based on the supply and dosage. For instance, report adenosine using J0153 (Injection, adenosine, 1 mg [not to be used to report any adenosine phosphate compounds]).