Billing and Coding: Cardiovascular Nuclear Medicine

Billing for cardiovascular nuclear medicine requires a valid ICD-10-CM diagnosis and, when applicable, the referring/ordering physician's name and NPI; diagnostic test claims should include results or the symptoms prompting the test. Advance Beneficiary Notices (ABN) and modifiers GA/GX/GY/GZ must be used per CMS rules (CMS-R-131 and occurrence code 32 for Part A MAC), noting that GA, GX, and GY are subject to automatic denial behavior and providers must notify beneficiaries in writing when they know a service may not be covered.

"For services that require a referring or ordering physician, the claim must report the referring/ordering physician's name and NPI."

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