Cardiology Coding Alert

Question: If a patient returns on a second day for the resting or stress portion of a SPECT scan because the test could not be completed the first day because of scheduling constraints, will my practice be reimbursed for the second day if we administered radiopharmaceuticals? Can I report 78990 to Medicare?

Georgia Subscriber

Answer: First, when your cardiologist performs the rest or stress portions of the SPECT scan on two separate days, you should report the test either on the first or second day using the full listing of codes (SPECT, wall motion, and ejection fraction) plus any medications supplied by your practice.

While logic may recommend that you choose the second day, some carriers want you to report the codes on the first day as the actual date of service. Check with your carriers to see which day they prefer.

Second, Medicare requires that you use an appropriate HCPCS code for radiopharmaceuticals and not the generic code 78990 (Provision of diagnostic radiopharmaceutical[s]) accepted by non-Medicare payers. Instead, you must report the specific radioisotope or stressing agent and the quantity injected. Choose from the following HCPCS codes:

 A9500 - Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose; also known as Cardiolite

 A9502 - Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m tetrofosmin, per unit dose; also known as Myoview

A9505 -Supply of radiopharmaceutical diagnostic imaging agent, thallous chloride TL-201, per millicurie; also known as Thallium

 J0152 - Injection, adenosine, 30 mg

 J1245 - Injection, dipyridamole, per 10 mg (also called Persantine)

 J1250 - Injection, dobutamine HCI, per 250 mg.