How would you recommend coding the following note:

TEST PROTOCOL: On 07/25/07 the patient was exercised on a motorized
treadmill, beginning at Stage I of the Bruce protocol. The patient
exercised for the totoal duration stated, achieving the maximum heart
rate noted. The patient was injected with Technetium 99 Myoview
during maximal treadmill exercise. SPECT imaging was begun
immediately after exercise with recovery. Reconstruction of the SPECT
tomograms was done using a quantitative analysis protocol.

Myocardial perfusion study was performed and gated wall motion images
were obtained during the stress in the vertical long-axis, horizontal
long-axis, and short-axis views.

On 07/26/07, first pass acquisition was obtained utilizing planar
imaging with the injection of the rest dose of Myoview. First pass
functional analysis was performed at rest with wall motion analysis.
Heart counts were evaluated after appropriate phase imaging
distributions. End-systolic and end-diastolic frames were then

On 07/26/07, baseline rest SPECT imaging was acquired one hour after
Technetium 99 Myoview injection was given. These images were obtained
using and SMV system.

NOTE: All tests performed in the physician's office so billing is
global. Stress test also performed (93015) and RPs billed for
(A9502). The docs are initially coding this as a regular stress test:
78465, 78478, 78480, plus the 93015 and A9502 as mentioned
(documentation not included for brevity). The dication for the above
is different than a regular "stress test" and I believe that the
first pass may be coded as 78481 or 78483, but there may be some
overlap in coding. Note there are CCI edits, but only for same DOS.

Thanks so much for your assistance.

Marti Troyer, CPC