I also code stress tests but do not code an EM visit. Normally, the chief complaint is documented and a brief history which would be included in the test. I cannot find any specific guidlines on this either.
The patient being referred for the stress test already has some type of sign or symptom or established diagnosis. I do not see why it would be necessary for the physician to do their own E/M if it was not requested in a consult.
The only thing I could find in the CPT book is "If the physician provding nuclear medicine services is also responsible for the diagnositic work-up and/or follow-up care of the patient, E/M service codes should be coded in addition to the nuclear medicine procedures." I can see if the patients primary care requests a cardiology consult and the cardiologist decides to order/perform the stress test the same day but otherwise I don't think an E/M visit should be coded just because the patient is new.
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