Cardiology Coding Alert

Question: Which codes apply to this case performed in our office? The patient has mitral valve disease. The service is a Lexiscan thallium stress test. Rest dose of thallium was injected, followed by rest scan images. Lexiscan was injected followed by the stress scan, and Myoview, followed by the stress scan images. The stress test was significant for left ventricular ejection fraction of 58 percent, and the SPECT perfusion images were significant for a moderate area of inferior wall fixed defect with partial reversibility during stress.

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Answer: Based on the information given, the most specific diagnosis code you can assign is 394.9 (Other and unspecified mitral valve diseases). The mitral valve is located between the left atrium and left ventricle.

For the complete stress test, you should 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).

In the not too distant past, you would have used multiple codes to report the perfusion imaging, wall motion, and ejection fraction studies. But now you need only a single code: 78452 (Myocardial perfusion imaging, tomographic [SPECT] [including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed]; multiple studies, at rest and/or stress [exercise or pharmacologic] and/or redistribution and/or rest reinjection).

You also should report the thallium, Lexiscan, and Myoview supply. Check the documentation to calculate the appropriate units. To report the thallium, use A9505 (Thallium tl-201 thallous chloride, diagnostic, per millicurie). For the Lexiscan, use J2785 (Injection, regadenoson, 0.1 mg), and assign A9502 (Technetium tc-99m tetrofosmin, diagnostic, per study dose) for the Myoview.