Cardiology Coding Alert
Sestamibi Stress Tests
Utah Subscriber
Answer: These two codes should be reported for the basic nuclear stress test, often referred to as a SPECT (single-photon emission computed tomography) scan:
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
93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report.
Gated imaging is often performed in conjunction with SPECT scans to assess coronary wall motion and measure ejection fraction. In such cases, add-on codes 78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) and 78480 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]) should also be reported.
Note: The SPECT scan and, if appropriate, the wall motion and ejection fraction studies should be specified in the patient's medical record.
The radiopharmaceutical used for nuclear scans may be reported separately using the appropriate supply code. Sestamibi (also known as Cardiolite) is reported to Medicare carriers with HCPCS code A9500 (Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose). If two doses are provided, a "2" should be noted in the units box of the claim form. Private carriers may require 78990 (Provision of diagnostic radiopharmaceutical[s]). Supplies reported using this code are not measured in doses, so the specific amount used should be entered in the message line of the claim form (paper or electronic). The administration of the radiopharmaceutical, such as tubing, needles, IV placement, etc., is included in the SPECT scan (78465) and should not be reported separately.
You Be the Coder and Reader Questions were answered by Sueanne Bicknell, RHIA, CCS-P, CPC, a cardiology coding and reimbursement specialist in Dallas; Sandy Fuller, CPC, a practice coder with Cardiology Consultants, an 11-physician practice in Abilene; Linda Laghab, CPC, a practice coder with Pediatric Management Group, a multispecialty practice at Children's Hospital in Los Angeles; Rebecca Sanzone, CPC, billing manager with Mid-Atlantic Cardiology, a 45-physician practice in Baltimore; Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.
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