Wiki cardiology -- nuclear stress precert

[kimberlybaggott@gmail.com]

the codes for the nuclear stress is cpt code 78452 then for the imaging A9502 & A9505 -- then if the test is pharm induced test use J0280 & J1245. Could someone please tell me there is something special that can done for the precert of this test due to the fact that the nurse I have spoken with make it hard to precert this test. Can anyone tell me the secret to get this test precerted.

 

[newmy9]

My first question would be - what payer are you pre certing with? So many have their own requirements. Go to the payer website to check their medical policies.

 

[jewlz0879]

In my exp with precert/ins, they will give you a precert, it's the reimbursement you have to worry about. However, I would make sure A) you have documented medical necessity B) you have a valid icd-9 (depending on the payor, they may have a specific LCD list. If you don't have a diagnosis on their LCD list, it won't be paid. Perfect example of this: 93325 and Aetna although it's not the primary procedure code, they are picky with what icd-9 codes are considered for reimbursement.