Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

This article provides billing and documentation guidance for non-emergent outpatient cardiac stress testing under LCD L38396: CPT 78434 must be reported only with CPT 78431 or 78492, and SPECT MPI includes left ventricular wall motion and ejection fraction assessment as well as attenuation correction (all included in the MPI service). Extensive documentation is required, including legible records, provider signature, support for ICD-10 and CPT coding, the ordering physician's stated clinical indication/medical necessity, justification for pharmacologic versus exercise stress, and formal interpretations for all segments; non-covered services per the LCD must not be billed as covered.

"CPT 78434 (gated SPECT) may be reported only in conjunction with CPT 78431 or CPT 78492 when billed for SPECT myocardial perfusion imaging (MPI)."

Sign up to see full coverage criteria, indications, and limitations.