Cardiology Coding Alert

When the chart reads, thallium stress test, how do you code? Very carefully, experts warn. That one extra word, thallium, written in front of a typical cardiology procedure means coding for it is anything but typical, warns Susan Callaway Stradley, CPC, CCS-P, senior consultant for Medical Group of Elliott Davis and Co., LLP, an accounting and consulting firm in Augusta, GA, .

Thallium, she notes, is one of the radioactive diagnostic imaging agents used in myocardial perfusion imaging (MPI) studies that evaluate how well blood is flowing to the myocardium. Its use should signal coders to venture outside the usual stress test range of codes (93015-93018) and into cardiovascular codes in the nuclear medicine section (78414-78499) of the CPT in order to optimize reimbursement, she says.

For example, a claim for a thallium stress test could contain as many as four CPT codes, including the following:

a stress test code - 93015-93018
a myocardial perfusion imaging code (MPI) - 78460-78465
a HCPCS code for the radiopharmaceutical
a HCPCS code for the pharmacological

Overlooking any one of these could mean youve missed reimbursement to which your practice may be ethically entitled. For example, MPI procedures do not include stress testing. So, failure to bill for it can be a loss of anywhere from $31 to $157 (depending upon whether you bill the global MPI code or just the professional component).

On the other hand, you can be in danger of upcoding, especially if you bill for an MPI reinjection when the second injection is considered part of the basic procedure. For example, a coder from Indiana asks, Our doctors do 78465 (myocardial perfusion imaging; tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification) on one day and then 24 hours later the patients come back for 78464 (tomographic [SPECT] single study at rest or stress [exercise and/or pharmacologic], with or without quantification). How can I correctly code for the reinjections?

The reinjection is not separately billable because the repeat imaging is inherent in the definition of 78465, explains Kenneth A. McKusick, MD, FACR, FACNP, coding and reimbursement chair for the Society of Nuclear Medicine.

So if you bill for 78465, the reimbursement would be about $697. Then if you billed for 78464 you would receive an additional $431 to which you are not ethically entitled. When the physician is performing a 78465, you cannot bill for the second injection as 78464 or you are being overpaid, Stradley cautions.

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