Cardiology Coding Alert

FYI: You may already know that the cardiologist who supervises the treadmill portion of a hospital-based nuclear study should report 93016 and 93018, but did you know that you shouldn't apply modifier -26 (Professional component) to either of these codes? 

The reason is the descriptors of 93016 and 93018 refer to the professional services. For example, the descriptor of 93016 refers only to the supervision of the stress test, one component of the nuclear medicine protocol. That doesn't mean, however, that you shouldn't apply modifier -26 to other associated codes for a nuclear study - but watch out. Hospital policies can fluctuate.

Modify the Way You Use Modifiers

You should append modifier -26 to 78465, 78478 and  78480 when the stress test takes place in the hospital. The hospital furnishes the space, utilities, equipment and technical staff for the study, so carriers will reimburse them for the technical component (-TC) of these studies. "If you were to submit your claim without appending modifier -26 with a place-of-service code for a hospital setting (such as, 21 or 22), your claim will more than likely be returned unpaid," Anderson says.

"We also go to rural clinics that have nuclear testing facilities, and in that case, we only bill for the professional portion using modifier -26," Kelchen says. "However, when we perform nuclear tests in our office, we do not use any modifiers because we own the equipment."

Tip: You can set up your system with different fee schedules based on whether or not you apply modifier -26. This helps your staff know that when you're billing a nuclear test performed in the hospital, you should receive less reimbursement than you receive for the tests performed in the office, Kelchen says.

Don't Fall Into the 78890-78891 Trap

If your nuclear medicine cardiologist did the dictation of the nuclear study, you shouldn't report 78890 (Generation of automated data: interactive process involving nuclear physician and/or allied health professional personnel; simple manipulations and interpretation, not to exceed 30 minutes) or 78891 (... complex manipulations and interpretation, exceeding 30 minutes) in addition to a myocardial perfusion study.

In the past: Some practices used to report these codes when they corrected the diagnostic images for attenuation or, in other words, the reduction of radiopharmaceutical energy that is detected, due to attenuation by soft-tissue structures and bone. Physicians could interpret this distortion as a false positive, or this distortion could cause a truly positive study to be dismissed as attenuation. Attenuation correction became available through most major gamma camera companies about 10 years ago.

"In my opinion, you should be able to report 78890 because you're using your computer to manipulate the data for interpretation, but Medicare and some insurance companies don't exactly see it that way," Lloyd says.

In the present: CPT 2005 specifies that code 78465 includes "attenuation correction when performed." You should not separately report 78890 and 78891 because the National Correct Coding Initiative (NCCI) bundles them into 78465. "If a third-party payer does process these codes for additional payment, don't get too excited - they will realize their error and retract payment," Anderson says.