Cardiology Coding Alert

Question: Are these the correct modifiers and quantity to report a nuclear stress test: two units of  78465-26, two units of 78478-26, and 78480-26?  Which modifiers?

Hawaii Subscriber Answer: You shouldn't report two units for all three codes:

 78465-26 - 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; professional component
 +78478-26 - Myocardial perfusion study with wall motion, qualitative or quantitative study (list separately in addition to code for primary procedure); professional component
 78480-26 - Myocardial perfusion study with ejection fraction (list separately in addition to code for primary procedure); professional component.  If the cardiologist performed the study over two days, you would still only report 78465 and 78478 one time. Notice how 78465 includes the words "multiple studies at rest and/or stress" in its descriptor, so you would be incorrect to report this code twice.

Heads-up: Cardiologists should report the stress test portion in any setting. In an office, you should use 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). In the facility setting, you should use 93016 (... physician supervision only, without interpretation and report) and 93018 (... interpretation and report only).

Editor's note: If you would like more information on this topic, refer to the audioseminar tapes, CDs and print transcripts conference "Nuclear Cardiology Coding Made Easy," presented by Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country.