Radiology Coding Alert

Question: Our radiologist interpreted tomographic myocardial perfusion imaging at rest and again at peak exercise. A Cardiolite^® injection preceded each scan. Is code 93016 appropriate?

Minnesota Subscriber

Answer: Code 93016 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report) is designated for reporting by the radiologist or cardiologist’s office. The radiologist is exclusively performing the interpretation portion of the study. Tomographic myocardial perfusion imaging, also known as single photon emission computed tomography (SPECT), is reported using code range 78451-78452.

Since the imaging includes a stress and rest study, you will report 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). The technique of the report should indicate separate injections of Cardiolite^® for the stress and rest portions of the exam.

Note: If the report indicates that the study was performed using planar technique, as opposed to SPECT technique, you will report the appropriate code from range 78453-78454.

Lastly, make sure to append modifier 26 (Professional service) to 78452 to indicate to the payer that the provider is billing for the radiological interpretation of the service.