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Dual Isotope Nuclear Stress Test - 78452 Problem

Oscar Posted Thu 06th of June, 2013 19:44:07 PM

Can someone answer my following question please...

My doctor is doing Dual Isotope Adenosine Nuclear Stress Test. Isotopes are A9502 (Myoview) & Thalium (A9505). For patients who are not able to walk on treadmill we are using Adenosine injecting along with Normal Saline (J7050) for creating the stress.
Here I have two questions
1) We are using A9502-Myoview 30mci, for which we are coding 2 units & we are using A9505-Thalium 3.6mci, for which we are coding 4 units. Billing these 2 & 4 units for these isotopes is correct or not as per dosage?

2) We are giving Adenosine IV in mixture with Normal Saline. Does the dosage of this Normal Saline must be 250cc. Because the HCPCS code for Normal Saline J7050 is showing for 250cc, so could someone help me with this "is it mandatory to use 250cc NS solution" in order to inject Adensoine.

I appreciate your help.

Thanks & Regards
Oscar M

SuperCoder Answered Sun 09th of June, 2013 22:49:44 PM

Here I have two questions
1) We are using A9502-Myoview 30mci, for which we are coding 2 units & we are using A9505-Thalium 3.6mci, for which we are coding 4 units. Billing these 2 & 4 units for these isotopes is correct or not as per dosage?

A9502: TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE
Code A9502 is coded per study dose. SNM recommends 2 units to represent rest study and stress study. http://interactive.snm.org/index.cfm?PageID=5026. Check for you payer’s policy on whether it considers the rest and stress phases to be a single study or two separate studies.

A9505: THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PER MILLICURIE
Because A9505 is codes as 1 unit per millicurie, 4 units for 3.6 mci is correct.

2) We are giving Adenosine IV in mixture with Normal Saline. Does the dosage of this Normal Saline must be 250cc. Because the HCPCS code for Normal Saline J7050 is showing for 250cc, so could someone help me with this "is it mandatory to use 250cc NS solution" in order to inject Adensoine.

I’m not sure I understand the question. There doesn’t appear to be a clinical requirement of 250cc, and the general rule for calculating units for HCPCS is you round up (so if 250 mg = 1 unit, then 400 mg = 2 units). With J7050, you’ll need to be sure the payer doesn’t consider saline to be a supply incidental to infusion, meaning it isn’t reimbursed separately.

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