Cardiology Coding Alert

Question: Which codes should I use for a SPECT myocardial perfusion stress test done in the hospital? Should I report 93016 and 93018?

Pennsylvania Subscriber

Answer: If the cardiologist performed the procedure and did the entire supervision and interpretation, you should report 78465-26 (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; professional component), 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) and 93018 (... interpretation and report only).
 
If your documentation includes ejection fraction, you should add +78480-26 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]; professional component) and, if it
includes wall motion assessment, +78478-26 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]; professional component).
 
Keep in mind: Sometimes the hospital will use one physician for the supervision and interpretation, while another does the readings later in the day. You may want to wait to code this test until the procedure reports come over from the hospital. 
 
Remember: The correct primary diagnosis to report on your claims for diagnostic tests is the finding - only if the test results are positive. If the test results are negative, you should only report the indication as the primary diagnosis. However, if the cardiologist performed the test for screening purposes, you should report the appropriate screening diagnosis (most likely a "V" code) as primary, regardless of the findings.