Cardiology Coding Alert

Question: How should I code this case performed at our office? The patient received Myoview for resting SPECT images. The next day, the patient had a treadmill test at our office with Myoview. Documentation indicates they couldn’t get a wall motion.

Minnesota Subscriber

Answer: For the imaging on both days, you should report one unit of a single code that covers both the rest and stress imaging: 78452 (Myocardial perfusion imaging, tomographic [SPECT] [including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed]; multiple studies, at rest and/or stress [exercise or pharmacologic] and/or redistribution and/or rest reinjection).

This code still applies even without wall motion. The descriptor indicates the code includes that service if performed, but doesn’t require it.

Tip: Use modifier 26 (Professional component) on 78452 if you’re reporting only the physician’s interpretation and not the imaging itself. You indicate the service was at your office, so you should report the global code rather than appending modifier 26.

To report the Myoview, use two units of A9502 (Technetium Tc-99m tetrofosmin, diagnostic, per study dose). You report two units because the code descriptor says “per study dose,” and rest plus stress equals two studies. Be sure to follow payer requirements as you may need to submit an invoice to show the price of the agent.

Remember to report the stress test. Because you mention the service was in the office, you likely are reporting the complete test, including performing the test, supervision, and the interpretation with report. Consequently, you should report 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report). When you need to report individual components instead, see 93016-93018.