Cardiology Coding Alert

Reader Question:

Consult Carrier Rules for Adenosine

Question: Should we be billing J0151 for the actual amount of Adenosine used during a nuclear scan, or should we bill for one unit (in milligrams) as a single dose? Our Medicare payer is reimbursing for each unit when we bill multiple units, and we're concerned that this might attract future audits.

Colorado Subscriber

Answer: Each carrier dictates how you should bill it for Adenosine, and their guidelines vary widely (see below). Use one of these three codes for Adenosine: J0150 (6 mg), J3490 (a generic code), and J0151 (90 mg).
Take a look at a sampling of three carrier positions on Adenosine billing:

  • Cigna - "Please do not use HCPCS code J0150 for billing Adenosine."
  • Cahaba - "Offices providing the 60-mg vial should begin using J0150 with number of service 10."
  • Palmetto GBA - "When up to 60 mg of Adenosine is administered, use HCPCS code J3490 to indicate use of the 60-mg vial. When between 60 and 90 mg of Adenosine is administered, use HCPCS code J0151 to indicate use of the 90-mg vial."
    Check your carrier's local medical review policy for specific guidance. But billing for 1 mg as a dose would be wrong because all of the codes include multiple milligrams.
     - Answers to You Be the Coder and Reader Questions were provided Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.