Cardiology Coding Alert

Question: When billing J1245, do payers require a different diagnosis code than used with the 78465? For example, do you need to use obesity, difficulty walking, wheelchair bound, arthritis, etc.? We are starting to see rejections for this code for diagnoses considered not medically necessary even when the rest of the study is paid. 


New York Subscriber

Answer: When you're coding a dipyridamole injection with 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification), you should make sure you put the diagnosis showing the reason the patient cannot exercise (such as 826.0, Fracture of one or more phalanges of the foot; closed), according to Empire Medicare of New York. You should attach this diagnosis to J1245 (Injection, dipyridamole, per 10 mg).

Occasionally, you may receive a rejection, but a telephone call to the appeals unit will usually take care of the problem.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.