Cardiology Coding Alert

Question: We would like to open our nuclear imaging department earlier than the rest of the practice so we can perform a few more SPECT studies on patients each day. Our nurse practitioner mentions that these services are within her scope of practice, but we are concerned because no physician will be in the building for these earlier tests. Is our concern warranted?
       
California Subscriber

Answer: For Medicare patients, your concern is warranted. SPECT studies typically include a stress test (93015) to facilitate imaging during stress as well as at rest. Stress tests have a "direct" physician supervision requirement as defined by Medicare. This means that a physician must be in the office or suite and available to assist should the need arise. This supervision requirement applies only in the office and only if a technician performs the stress test. If the nurse practitioner personally administered the stress test, you would not need to worry about this supervision requirement. But stress tests are not typically administered by nurse practitioners.  
 
Diagnostic test supervision requirements do not apply in the hospital setting to tests personally performed by nurse practitioners or to diagnostic tests provided to many non-Medicare patients. Therefore, you could arrange your schedule so that only non-Medicare patients are slated in these earlier slots. And, the NP could perform resting images first because the imaging service codes (such as 78465) do not have direct physician supervision requirements.