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is there a procedure code i can use to bill for the injection of the contrast agent A9500 used in the myocardio perfussion studies? this is administered via IV. or is it being bundled into the test itself?
 

jgf-CPC

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Myocardial Perfusion Studies with Thallium

There may be four separate codes required to obtain reimbursement and track utilization correctly for myocardial perfusion and cardiac blood pool imaging studies; these codes along with the appropriate line item data are to be entered on the CMS –1500 or UBClaim Form.

1. Selection of HCPCS code for the radiopharmaceutical/imaging agent
2. Selection of CPT codes for the myocardial perfusion procedure(s), any add-on procedures, and stress testing
3. Selection of HCPCS code for any pharmaceutical stress agent, and injection/infusion administration
4. ICD-9-CM diagnosis codes and documentation of medical necessity

1. Selection of HCPCS code for the radiopharmaceutical/imaging agent


HCPCS Code Description
A9505 Supply of radiopharmaceutical imaging agent, thallous chloride TL-201, diagnostic, per mCi

When billing Thallium make sure you round the dose up to the next whole number - if you inject 3.5mCi bill 4 units of A9505

2. Selection of CPT codes for the myocardial perfusion procedure(s), plus add-on procedures and stress testing, as appropriate

As noted in American Medical Association, CPT-4 2007, myocardial perfusion and cardiac blood pool imaging studies may be performed at rest and/or during stress. The table below lists the appropriate procedure codes. When performed during exercise and/or pharmacologic stress, the appropriate stress test code from the 93015-93018 series should be reported in addition to these procedure codes.

CPT Code Description
78460 Myocardial perfusion imaging; (planar) single study at rest or stress (exercise and/or pharmacologic), with or without quantification
78461 Myocardial perfusion imaging; multiple studies, (planar) at rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification
78464 Myocardial perfusion imaging; tomographic (SPECT), single study at rest or stress (exercise and/or pharmacologic) with or without quantification
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
78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing
78473 Cardiac pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification
78481 Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification
78483 Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification
78494 Cardiovascular blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing

Add –on Procedure codes

CPT Code Description
78478 Myocardial perfusion study with wall motion, qualitative or quantitative study (list separately in addition to code for primary procedure) (Use 78480 in conjunction with codes 78460, 78461, 78464,78465)
78480 Myocardial perfusion study with ejection fraction (list separately in addition to code for primary procedure) (Use code 78481 in conjunction with codes 78460,78461,78464, 78465)
78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest with right ventricular ejection fraction by first pass technique (list separately in addition to code for primary procedure) (Use 78496 in conjunction with code 78472)

Cardiovascular Stress Test, when performed

CPT Code Description
93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)
93016 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision only, without interpretation and report (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)
93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)
93018 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only (when performed, should be coded in addition to code(s) 78460-79465, 78472, 78473, 78478, 78480, 78481, 78483, 78491, and 79492)

3. Selection of HCPCS/CPT codes for any pharmaceutical stress agent


HCPCS Code Description
J0152 Injection, adenosine, 30 mg
J1250 Injection, dobutamine HCI, per 250 mg (Dobutrex)
J1245 Injection, dipyridamole, per 10 mg (Persantine IV)
 
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