If the cardiologist performs only a rest or stress scan (single study), you should use code 78464 for the single study scan. 2. Add 78478 when the nuclear scan is a gated study in which the cardiologist performs a wall motion evaluation.
What you can expect
You may need a nuclear stress test if a routine stress test didn't pinpoint the cause of symptoms such as chest pain or shortness of breath. A nuclear stress test may also be used to guide your treatment if you've been diagnosed with a heart condition. Your doctor may recommend a nuclear stress test to: Diagnose coronary artery disease.
Your doctor may also perform a nuclear stress test to:
Why Should I Trust a Nuclear Stress Test?
78452 : Nuclear stress : 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/ ...
The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. Use ICD-10 code Z01. 810 for those tests which were performed to evaluate pre-operative risk but for whom the test was negative. (A positive test should be coded with the results of the test.)
CPT® Code 93015 in section: Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress.
Stress tests are most often used to: Diagnose coronary artery disease, a condition that causes a waxy substance called plaque to build up in the arteries. It can cause dangerous blockages in blood flow to the heart. Diagnose arrhythmia, a condition that causes an irregular heartbeat.
CPT® Code 93350 in section: Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed.
ICD-10 Code for Encounter for screening for cardiovascular disorders- Z13. 6- Codify by AAPC.
93018 is interpretation and report only. So that's a professional piece. If you only did the supervision only, then that's going to be your 93016. So you want to code what your physician did, if an entity that owns the equipment and the physician did all the work, they're going to code 93015.
CPT® 93227 in section: External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a ... more.
CPT® Code 93351 in section: Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed.
Most insurance companies will cover this, if you have good data from your doctor that this is really necessary and the information he or she wants just can't be achieved with a regular stress test.
Does Medicare cover a nuclear stress test? If a doctor orders a nuclear stress test to diagnose you or rule out an illness, Medicare will cover the test.
A regular stress test shows the EKG, heartrate and blood pressure while you are walking on a treadmill. A nuclear stress test shows your physician pictures of the blood flow to the heart muscle, in addition to the EKG, heartrate and blood pressure.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act (SSA), 1862 (a) (1) (A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” Title XVIII of the Social Security Act, 1862 (a) (7) and 42 Code of Federal Regulations, Section 411.15, exclude routine physical examinations. Title XVIII of the Social Security Act, 1833 (e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. CMS Manual System, Pub.
Article Text The following coding and billing guidance is to be used with its associated Local coverage determination. Supportive documentation evidencing the condition and treatment is expected to be documented in the medical record and be available upon request. Documentation in the patient’s medical record must substantiate the medical necessity of the service, including the following: • A clinical diagnosis, • The specific reason for the study, • Reason for performing a stress echocardiogram as opposed to only an electrical stress test, • The reason for using any pharmacological stress, and • The reason for a stress echocardiogram if a stress nuclear test is also performed for the same patient for the same clinical condition. Document the referral order (written or verbal) in the patient’s medical record.
The following list of ICD-10-CM codes applies to cardiovascular stress testing CPT codes 93015, 93016, 93017, 93018, 93350, 93351 93352 and J0153. Since J0395, J1245, and J1250 may be billed for indications other than pharmacological stress agents with cardiovascular testing, the use of these drugs is not subject to the following list of ICD-10-CM diagnoses:.
Any diagnosis inconsistent with the Indications and Limitations of Coverage and/or Medical Necessity section, or the ICD-10-CM descriptors in the ICD-10-CM Codes That Support Medical Necessity section.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
TYPE OF STRESS TEST: Lexiscan Cardiolite#N#INDICATIONS : Positive risk factors, history of chest pain, EKG abnormality, patient is unable to exercise because of chronic back pain.#N#CONSENT: Before the procedure, the patient provided written consent.#N#HISTORY: Baseline EKG shows sinus rhythm with poor R-wave progression in the anterior leads, and maybe a hint of inferior ST depression in II and III. Baseline blood pressure is 136/74. Baseline heart rate is 85 beats per minute.#N#DESCRIPTION OF PROCEDURE: 0.4 mg of Lexiscan was given over 10 seconds. Immediately after infusion the patient denied any chest pain. Blood pressure was 128/75, pulse 88. The EKG remained at baseline abnormality. However, during recovery there was some QT prolongation, but the patient had no chest pain. At 4 minutes of recovery, the patient's blood pressure was 130/74 with heart rate of 86. EKG, as mentioned, involved some mild QT prolongation. There was no other ST-T abnormality.#N#IMPRESSION:#N#Baseline abnormal EKG with positive risk factors. There is no lexiscan-induced chest pain or shortness of breath.#N#Baseline abnormal EKG with Lexiscan shows no diagnosed ST depression or ST elevation; however, there is a QT prolongation with Lexiscan infusion.#N#Final nuclear imaging depending on Radiology interpretation.
There was no other ST-T abnormality. Baseline abnormal EKG with positive risk factors. There is no lexiscan-induced chest pain or shortness of breath. Baseline abnormal EKG with Lexiscan shows no diagnosed ST depression or ST elevation; however, there is a QT prolongation with Lexiscan infusion.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act (SSA), 1862 (a) (1) (A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” Title XVIII of the Social Security Act, 1862 (a) (7) and 42 Code of Federal Regulations, Section 411.15, exclude routine physical examinations. Title XVIII of the Social Security Act, 1833 (e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. CMS Manual System, Pub.
A cardiovascular stress test is a diagnostic test designed to evaluate a patient for the presence or the severity of coronary artery disease (CAD), exercise-induced arrhythmias or hemodynamic changes, and/or cardiac functional capacity.