In recent years, billing for nuclear scans as it relates to coding, has been modified to more accurately reflect the provider services and thus, reimbursement for patient care. We are finding, however, that in internal medicine offices or cardiology groups, where there would likely be fewer conversations about these changes than in a nuclear practice, more clarification may be needed.
Decoding the billing code process
To be clear, the coding itself has not changed, but who can use designated codes have changed. Medicare is very specific as to the way in which they require the submission. The most confusion comes with the series 93015 through 93018 codes. With any test, there’s a differentiation among whether you supply the equipment, supervise the procedure, or interpret the report. Billing for anything other than your specific function, especially when it pays a higher fee, leads to non-compliance and possibly additional scrutiny via an audit. These are typically innocent mistakes that can lead to much larger issues. With that in mind, here is a list of basic codes for billing MPI SPECT that may be helpful:
- 78452 – Multiple Myocardial Perfusion Imaging, at stress and at rest. This code should only be billed once.
- A9500 – The “A” series codes relate to radiopharmaceuticals. A9500 represents Technetium tc-99m sestamibi, diagnostic. This is a per study dose and should be billed for 2 units. If sestamibi is used, bill NDC code 65857-0500-05.
- J0153 – The “J” series codes describe drugs. J0153 represents an injection of adenosine – this should be billed 1 unit for each milligram. You might also use J2785, an injection of Lexiscan and should be billed for 4 units.
- 93015 – This is the global code for cardiovascular stress testing. 93015 should only be used if your practice owns the stress equipment and your physician can interpret the test and issue the report.
- 93016 – The second in the cardiovascular stress test series, this code should be used if you provide supervision only, without interpretation or report.
- 93017 – The third in the cardiovascular stress test series, this code should be used if you provide tracing only, without interpretation or report.
- 93018 – The fourth in the cardiovascular stress test series, this code should be used if you provide interpretation and report only, without supervision.
Using the correct codes is critically important for accurate reimbursement. Knowing which codes to use and why helps increase overall compliance and, above all, properly reflects the procedure that was performed.