Test Yourself:
Nuclear Test Case Study
Published on Sat Mar 01, 2003
How much do you really know about coding nuclear stress tests? Try supplying the codes for the following scenario provided by a coding expert, and then look at the box below and compare your answers with the expert's response.
Scenario:
A patient complaining of chest pain comes into the office for an adenosine stress test. He has high cholesterol and a strong family history of heart disease. He weighs 180 pounds, and based on your chart, you see that he requires 73 mg of adenosine. The patient has both resting and stress images, which are gated.
Answer: You should use ICD-9 codes 786.50 (Chest pain, unspecified) for the chest pains, 272.4 (Other and unspecified hyperlipidemia) for high cholesterol, and V17.4 (Family history ... other cardiovascular diseases) for family history of cardiovascular disease.
Because the patient had both resting and stress scans, you would report 78465 (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) for multiple studies.
The study was gated, which means that the physician measured wall motion and ejection fraction. You would report add-on code +78478 (Myocardial perfusion study with wall motion, qualitative or quantitative study [list separately in addition to code for primary procedure]) for the wall motion evaluation and +78480 (Myocardial perfusion study with ejection fraction) for the ejection fraction measurement.
Report A9500 x 2 (Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose) for the sestamibi dosage because the patient received injections for both rest and stress scans.
For the stress test, report 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) even though the patient had stress induced with adenosine and did not use a treadmill or exercise bicycle.
There are several coding strategies for reporting the stressing agents to Medicare carriers. Because the patient had 73 mg of adenosine rather than the entire contents of the 90-mg vial, some coding experts suggest reporting J0151 x 1 (Injection, adenosine, 90 mg) for one dose of adenosine from a 90-mg vial and indicating in box 19 of the CMS 1500 form that you used 73 mg but are reporting the J0151.
Another strategy is to use the unclassified-drug code J3490 (Unclassified drugs) for the adenosine dosage and enter the actual dosage used in box 19 of the form. Consult your Medicare carrier and private payers for specific guidelines on stressing-agent reporting. | |
