Medical Billing Forum

Coding => Coding => Topic started by: PMBS on November 06, 2008, 09:02:32 AM

Title: Stress Testing
Post by: PMBS on November 06, 2008, 09:02:32 AM
I am trying to find out if anyone knows if there is an LCD for Stress testing.  I can't seem to find one and Medicare has denied codes 78465, 78478, 78480 for invalid diagnosis.

I went on the Medicare website but I can't seem to find anything on the stress testing.  Does anyone know where I can get some information on this?

Thanks
Title: Re: Stress Testing
Post by: Michele on November 06, 2008, 07:22:59 PM
I'm not sure what area you are in, but I searched my LCD's and there wasn't anything for any of those codes.  I would recommend that you call Medicare and ask them to point you to information regarding those codes.  They should be able to help you find documentation supporting the denial and what diagnosis codes they are covered for.

Michele
Title: Re: Stress Testing
Post by: AIR on December 13, 2008, 12:17:28 PM
Look it up as Myocardial Perfusion Imaging or Cadiovascular Nuclear Medicine check L3622. Another good LCD is called LCD for Radiopharmaceutial agents L7388 which explains which drugs are used with each study.  There are only certain diagnosis codes that can be used with these CPT codes but never use 414.01 for Medicare since although is listed on the LCD is always denied as not medically necessary and Medicare logic for this is that this study is used to detect CAD not if the patient already has it.  In addition to the CPT codes you listed, the Stress Test (93015) unless billed by another physician is also added, but 2 units Sestamibi (A9500) must always be coded cause this study cannot be performed without it.  There are cases in which an additional drug is used like Adenosine (J0150), Dobutamine (A1250) or Persantine (J1245).  I do a lot of Nuclear Medicine Coding and the only problem I have so far is with the Medicare and the persantine J1245 item its always denied for diagnosis no matter which code I use but maybe is a local thing, everything else gets paid.  This denial started on the last quarter of 2007 before that it was always paid.     

Samples:

Persantine Stress Test
ICD-9 Code 413.9

78465
93015
78478
78480
A9500 (2)
J1245  (1-6 depending on patient's weight)

Adenosine Stress Test
ICD-9 Code 786.50

78465
93015
78478
78480
A9500 (2)
J0150

Dobutamine Stress Tes
ICD-9 Code 411.1

78465
93015
78478
78480
A9500 (2)
A1250

Hope this helps you.

AiR
Title: Re: Stress Testing
Post by: ppatel on January 14, 2009, 03:53:57 PM
In billing for nuclear stress testing, does anyone know if you can bill 36000 - insertion of IV into a vien, and 96365 - IV infusion of a drug?
Title: Re: Stress Testing
Post by: Michele on January 14, 2009, 05:10:19 PM
The information I have says that you should not bill for the 36000 when billing for the intravenous infusion (96365). 

If anyone else has info on this, please share.

Michele
Title: Re: Stress Testing
Post by: ppatel on January 14, 2009, 07:01:10 PM
ok, but can you bill 96365 when billing for a Nuclear Stress Test with the following codes:
Persantine Stress Test
ICD-9 Code 413.9

78465
93015
78478
78480
A9500 (2)
J1245  (1-6 depending on patient's weight)

Adenosine Stress Test
ICD-9 Code 786.50

78465
93015
78478
78480
A9500 (2)
J0150

So,
In addition to above, can you bill 96365?
Title: Re: Stress Testing
Post by: Michele on January 14, 2009, 09:00:33 PM
It's going to vary per insurance carrier but I don't see anything to indicate you shouldn't bill the 96365 with the codes you have.

Michele
Title: Re: Stress Testing
Post by: ppatel on January 15, 2009, 09:58:11 AM
I am sorry, I should be more specific.  I am in Southern California, we use Palmetto, who have been horrible by the way.  So does any one know about billing 96365 IN ADDITION TO billing for a Nuclear Stress Test with the following codes:

Persantine Stress Test
ICD-9 Code 413.9

78465
93015
78478
78480
A9500 (2)
J1245  (1-6 depending on patient's weight)

Adenosine Stress Test
ICD-9 Code 786.50

78465
93015
78478
78480
A9500 (2)
J0150

Has anyone received payment by doing this?
Title: Re: Stress Testing
Post by: Michele on January 15, 2009, 06:00:41 PM
I don't have experience with Palmetto.  Hoping someone else on the forum has and will help out.

Michele