Cardiology Coding Alert

In contrast to wall motion studies, ejection fraction calculations detail the percentage of blood that the ventricle empties during systole, Gajewski says. For these measurements, report +78480 (Myocardial perfusion study with ejection fraction [list separately in addition to code for primary procedure]) in addition to 78460-78465, depending on whether the cardiologist performs a single study or multiple studies (see our myocardial perfusion imaging clip-and-save chart on page 43 for more information on choosing the correct imaging code).

Answer: You should report 78478 and 78480 if the practitioner performs, interprets and documents additional studies beyond standard perfusion imaging (78460-8465).

Some Medicare LMRPs list codes 78478 as Heart wall motion, add-on and 78480 as Heart function add-on, says Cynthia Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist LLP in Omaha, Neb. "The add-on codes report additional tests performed with codes 78460-78465 and describe the characteristics of each type of test, including whether it is a single study or multiple studies."

Warning: You should never report these add-on codes with 78466 (Myocardial imaging, infarct avid, planar; qualitative or quantitative), 78468 (... with ejection fraction by first pass technique) or 78469 (... tomographic SPECT with or without quantification), because "those codes represent a nuclear imaging method of testing that evaluates the presence of myocardial infarction, ischemia or ventricular function," Swanson says. Codes 78466-78469 "may provide information related to the presence and extent of injured heart muscle, defines size and  location of infarct and assesses the outlook after acute myocardial infarction (MI)."

Codes 78466, 78468 and 78469 represent older technologies and are more limiting in what they show cardiologists, says Kathy Zinger, BA, CMM, RMC, office manager of Parkside Cardiology in Colorado Springs. Therefore, you generally wouldn't submit these codes as frequently as you'd report 78460-78465.

Question 3: Should we report J0150 or J0151 for the adenosine that we use during cardiac stress testing?

Answer: Adenosine divides into two separate products: Adenocard, which physicians use when treating paroxysmal supraventricular tachycardia (PSVT), and Adenoscan, a pharmacological stress agent.

Cardiologists typically inject 90 mg of Adenoscan per dose. Practices often want to report J0151 (Injection, adenosine, 90 mg) for this injection, but payers will usually reject J0151 when you report it as a pharmacological stress agent because HCPCS deleted J0151 in 2004. Instead, most carriers, such as HGSA, a Part B carrier in Pennsylvania, recommend that you use the new HCPCS code J0152 (Injection, adenosine, 30 mg [not to be used to report any adenosine phosphate ompounds; instead use A9270]) for Adenoscan injections.

The only difference between the now obsolete J0151 and the new J0152 is the dosage. "We include the amount on the claim with no need to send in an invoice," Gajewski says.

Avoid J0150 for Adenosine During Stress Testing

Self-defense: You should never report J0150 (Injection, adenosine, 6 mg [not to be used to report any adenosine phosphate compounds; instead use A9270]) to bill adenosine that you use during cardiac stress testing, unless you are specifically instructed by a  payer. Even though some practices erroneously report this code simply to collect quick reimbursement, it is not considered correct coding. You should report J0150  only if you use it as an antiarrhythmic medication. For myocardial perfusion studies, you should report J0152.

Don't confuse adenosine with radiopharmaceutical imaging agents used during myocardial perfusion studies. The most popular of these include Thallium (A9505, Supply of radiopharmaceutical diagnostic imaging agent, thallous chloride TL-201, per millicurie), Cardiolite (A9500, Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose), and Myoview (A9502, Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m tetrofosmin, per unit dose).

Keep in mind that 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) for the stress test in the office setting, and 93016 (... physician supervision only, without terpretation and report) and 93018 (... interpretation and report only) if you perform the stress test in a facility.

Answer: When your physician interprets wall motion and ejection fraction studies but your practice did not furnish the technical portions of the service, you should append modifier -26 (Professional component) to the appropriate add-on code.

The test's technical portion, which the facility will report, includes payment for the technical staff who administered the wall motion study, utilities and supplies. Physicians typically bill the professional component only in hospital settings or then someone requests their interpretation of a test that an outside facility administered. Modifier -26 tells the insurer that you are billing only for the cardiologist's interpretation.

Answer: Yes, you can bill 78478 and 78480 concurrently if your physician orders both a wall motion and an ejection fraction study during a gated SPECT study, provided that both tests are medically necessary.

Caveat: Unlike the add-on codes, you can report only one code from the myocardial perfusion study group (78460-78469) on any given day. You should use only the code that describes the most extensive primary perfusion study. Insurers will reimburse rest/stress protocols 78480 and 78478 as one test, regardless of whether the test was done on one day or over two days.