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Stess Tests

  1. #1
    Default Stess Tests
    Medical Coding Books
    I work in a rural family medicine practice. We have a doctor that has been doing stress tests at the local hospital for years - outpatient. I charge 93016 and 93018 for all Medicare plans and for all others 93015 - this is just the dr portion of the charge. Are these codes correct? He has discussed with some colleagues about this and their reimbursement is way more than ours - they own their own equipment. Are the codes correct that we are using for our professional component?

  2. #2
    We code 93016, 93018 when the pt does not have the nuclear portion done. If the nuclear portion is done we also code 78452/26 along with the 93016 and 93018. We only used the 93015 when we did the stress test in our office. Hope this helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    The 78452 we were told was to charged only by the hospital. Do you have any documentation on this to take to the dr?

  4. #4
    Medicare Reimbursement for Nuclear Cardiology
    2010 DELETED CPT® codes1:
    Deleted 78465 SPECT multiple myocardial perfusion imaging
    Deleted 78478 myocardial perfusion wall motion
    Deleted 78480 myocardial perfusion ejection fraction calculation
    For 2010 SPECT 78465 myocardial perfusion imaging with wall motion (78478) and
    ejection fraction (78480) are bundled into one new CPT® code – 78452.
    784522- Myocardial perfusion imaging, tomographic (SPECT) (including attenuation
    correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated
    technique, additional quantification, when performed); multiple studies at rest and / or
    stress (exercise or pharmacologic) and / or redistribution and / or rest reinjection.
    Medicare Hospital Outpatients Payments Payment
    2009 78465 - 78478 and 78480 bundled with 78465 $774.133
    2010 78452 - includes SPECT, wall motion, ejection fraction $775.094
    2009 78492 PET myocardial perfusion imaging $1156.873
    2010 78492 PET myocardial perfusion imaging $1432.871
    93017 Cardiovascular stress test 2010 Payment $176.175
    Medicare Physician Office Setting
    2009 78465 + 78478 +78480
    2010 78452 - includes SPECT, wall motion, ejection fraction
    2009 78492 PET myocardial perfusion imaging Carrier Priced
    2010 78492 PET myocardial perfusion imaging Carrier Priced

  5. #5
    Jacksonville Florida
    Quote Originally Posted by DHARRIS View Post
    The 78452 we were told was to charged only by the hospital. Do you have any documentation on this to take to the dr?
    If your doctor also read the nuclear portion of the testing, assumming that was also done with the stress, then yes, you can bill the 78452. You would just need to add mod 26 on it. My docs read nucs all the time at the hosp. They are billed:


    if the documentation supports those codes. Now sometimes they will read just a single study, which would then be 78451-26

    if its just a regular stress test that they are reading, then it would just be the 93016 & 93018.

    Hope that helps
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  6. #6
    Default stress test question
    Forgive me for sounding ignorant, but I'm confused on this! If a physician supervises, does I&R , why wouldn't 93015-26 be billed? Seems to me that 93016 and 93018 are contradictory. What am I missing here? Any help would be appreciated. Thanks!

  7. Default
    jammie mack is correct!

  8. #8
    Cardiac stress test codes are one of those services where you don't put -26 or -TC modifiers on them. Stress testing actually has codes that are THE professional component and THE technical component and if you do both the professional/technical components you would report the "global" code.

    93015 Stress test done in office (global code)
    93016 physician monitoring
    93017 ECG tracing (technical component; code is 100% technical so no -TC modifier needed)
    93018 interpretation and report

    93016/93018 is the professional components of the stress test and are 100% professional so you wouldn't put the -26 modifier on.

    Jessica CPC, CCC

  9. #9
    Thanks very much, Jessica!

  10. Red face single vs multi-strudy nuc stress tests
    Can I get feedback on whether or not multi-views (supine and prone) during a stress only test would constitute the use of 78452 (Multi-study)...?
    I'm not seeing that specified as an indicator that multi-views increase the single stress test to multi... this is not an event where both the rest and stress are done

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