Cardiology Coding Alert

Learn which date of service CMS says you should use If you're wondering how many doses of Cardiolite you should report for both a rest and stress nuclear medicine test, we've got answers. Read through these radiopharmaceutical coding guidelines, and then test yourself with the following two-day challenge. Bulk Up on Radiopharmaceutical Basics In 2006, HCPCS revised the A codes for Cardiolite, Myoview and Thallium. What's important to note is the codes for Cardiolite and Myoview have a specified limit: Cardiolite: A9500 -- Technetium Tc-99m sestamibi, diagnostic, per study dose, up to 40 millicuries Myoview: A9502 -- Technetium Tc-99m tetrofosmin, diagnostic, per study dose, up to 40 millicuries Thallium: A9505 -- Thallium Tl-201 thallous chloride, diagnostic, per millicurie. You'll use these HCPCS codes depending on the type of radiopharmaceutical and the dosage amount. Example: The physician uses two doses of Myoview to perform a myocardial perfusion study that merits 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). The physician uses the first dose to perform myocardial perfusion imaging at rest. The cardiologist then uses the second for imaging at maximum exercise. Each dose of Myoview is less than 40 millicuries. If your physician provides the Myoview (that is, he performs the test in your office), report two units of A9502.
Examine This Scenario
Some practices use a two-day imaging protocol. In these cases, the physician obtains one set of images (rest or stress) on day one and the other set on day two. Two-day protocols throw something of a curve ball into the mix. First, look at this actual procedure: On the first day, the cardiologist performed the rest portion of a myocardial perfusion test, wall motion evaluation and ejection fraction calculation. He used 27 millicuries of Cardiolite. On the second day, the physician performed a stress test and used another 27 millicuries of Cardiolite. For this service, you'll report the following codes for the rest portion: 78465 +78478 -- Myocardial perfusion study with wall motion, qualitative or quantitative study (list separately in addition to code for primary procedure) +78480 -- Myocardial perfusion study with ejection fraction (list separately in addition to code for primary procedure) A9500 (1 unit). For the stress portion, you'll add the following codes to the others: 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 A9500 (1 unit). Demystify the Number of Units You Should Report Most carriers recommend that as long as the radiopharmaceutical doses (A9500) are less than 40 mCi on each day (which would total more [...]