Billing and Coding: Cardiovascular Nuclear Medicine

Cardiovascular nuclear medicine is covered when medical necessity is documented—particularly for risk assessment or re-evaluation in patients with known atherosclerotic heart disease who have not had revascularization within the prior 2 years, for blood pool scans to assess ejection fraction prior to device implantation when the plan and results are documented, and for simultaneous first-pass cardiac function studies when documented. Claims must include a valid ICD-10-CM diagnosis code, referring physician name and NPI when required, and complete medical records (history, exam, test results, formal reports); tests repeated without changes in cardiac signs or symptoms are not considered medically necessary. Procedure coding is subject to NCCI and OPPS edits and specific CPT code combinations require explicit documentation of technique and laboratory capability.

"Cardiovascular nuclear medicine testing is reimbursable for risk assessment or re-evaluation in asymptomatic patients or patients with stable symptoms who have known atherosclerotic heart disease o..."