?? Stress Test w/ Nuclear Myocardial Perf Study

[littlebitt00]

As of January 2013, Medicare is reducing the payment on the stress test (93015) portion of the nuclear myocardial perfusion study. Would it be inappropriate to append a modifier 59 on the 93015 in conjunction with the 78452?

 

[OPENSHAW]

Hello,
CPT Code 93015 does not need a Modifier 59. We do not attach modifier 59. I would not. Thank you!

 

[littlebitt00]

59

We have not been appending the modifier 59 to the 93015. However, Medicare is appending a modifier 51 and reducing the reimbusement for the 93015.

 

[lmuzhai]

I need help AAPC Members please HELP!!!

I currently work at an Out-Patient Cardiovascular Physicians Office in Michigan. We render Nuclear Stress Study Services in our Office.

Currently the CPT Codes we use to bill for a Nuclear Stress Study are the following:

78452
A9500
J1280
J0280
93015
Major concern about CPT Injection Code (36410)
Depending on the type invasive study the patient needs we also bill J2785 (Lexiscan 0.4mg)

Michigan Medicare and BCBS of Michigan reimburse for CPT Code 36410

Michigan Medicaid along with Medicaid HMO Plans do not pay for CPT Code (36410)

BCBS of Michigan Provider Relations informed uses that technically even though Michigan Medicare and BCBS of Michigan recognize the CPT Code (36410) and reimburse for the services we shouldn't use that CPT Code in a Nuclear Stress Study.

Is there a replacement CPT Code we can use to replace the CPT Code (36410)?

And what are the consequences/outcome from using that CPT Code to be billed for to major Health Insurance Companies?

Please someone help, it's greatly appreciated.

Thank You.
Laida

 

[lmuzhai]

Cardiovascular Stress Study (HELP)

I need help AAPC Members please HELP!!!

I currently work at an Out-Patient Cardiovascular Physicians Office in Michigan. We render Nuclear Stress Study Services in our Office.

Currently the CPT Codes we use to bill for a Nuclear Stress Study are the following:

78452
A9500
J1280
J0280
93015
Major concern about CPT Injection Code (36410)
Depending on the type invasive study the patient needs we also bill J2785 (Lexiscan 0.4mg)

Michigan Medicare and BCBS of Michigan reimburse for CPT Code 36410

Michigan Medicaid along with Medicaid HMO Plans do not pay for CPT Code (36410)

BCBS of Michigan Provider Relations informed uses that technically even though Michigan Medicare and BCBS of Michigan recognize the CPT Code (36410) and reimburse for the services we shouldn't use that CPT Code in a Nuclear Stress Study.

Is there a replacement CPT Code we can use to replace the CPT Code (36410)?

And what are the consequences/outcome from using that CPT Code to be billed for to major Health Insurance Companies?

Please someone help, it's greatly appreciated.

Thank You.
Laida

 

[jewlz0879]

I wouldn't bill 36140 with Nuc's. I would only bill that code if we were performing a venipuncture requiring physician skill on a pt 3 years or older. I don't see any reason to bill this code with a nuclear and if my physician were doing routine venipuncture for actual lab tests, then I would consider 36415, as 36410 states do not bill for routine svcs.

 

[lmuzhai]

Cardiovascular Stress Study (HELP)

Thank you for the quick response

Is there a replaceable CPT Code that can fit the criteria of the Venipunture CPT Code (36410)?

Or perhaps bill the Nuclear Stress Study Codes differently?

 

[lhallstrom]

CV stress with myocardial perfusion study

Reimbursement reduction on CV Stress (93015) reported with nuclear stress test (78451/2) is due to Medicare's Multiple Procedure Payment Reduction (MPPR). It is doubtful modifier -59 will make any difference in reimbursement. Don't necessarily like it, but that is the way it is!