About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Cardiac Radionuclide Imaging L33457. Claims submitted for stress tests performed as preoperative evaluation of patients without symptoms of coronary artery disease (CAD) who are deemed to be at moderate risk must document 1 of the following at-risk conditions in the medical record: diabetes mellitus (DM) with complications, peripheral vascular disease (PVD), aortic aneurysm or cerebrovascular disease.
Documentation requirements
Use of these codes does not guarantee reimbursement. The patient’s medical record must document that the coverage criteria in the related LCD have been met.
Claims submitted for stress tests performed as preoperative evaluation of patients without symptoms of coronary artery disease (CAD) who are deemed to be at moderate risk must document 1 of the following at-risk conditions in the medical record: diabetes mellitus (DM) with complications, peripheral vascular disease (PVD), aortic aneurysm or cerebrovascular disease.
NOTE: Z01.810 is to be used to code claims for pre-operative evaluation. This code is NOT appropriate for establishing a baseline prior to the administration of cardiotoxic chemotherapy.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 78431 | HCPCS | Covered |
| 78451 | HCPCS | Covered |
| 78452 | HCPCS | Covered |
| 78453 | HCPCS | Covered |
| 78454 | HCPCS | Covered |
| 78472 | HCPCS | Covered |
| 78473 | HCPCS | Covered |
| 78481 | HCPCS | Covered |
| 78483 | HCPCS | Covered |
| 78491 | HCPCS | Covered |
| 78492 | HCPCS | Covered |
| 78494 | HCPCS | Covered |
| 78496 |