What is the correct way to code cases that involve patients who are having a multi-day nuclear medicine test, such as a two-day cardiac stress test in an outpatient setting (hospital-based)? Sometimes, but not frequently, we’ll have a patient come for the rest portion and then come on a second day for the stress portion of the test.


You would report the multiple study code once, even if performed on separate days. There is no national policy regarding date of service (DOS), although some payers have specific policies.  In the absence of a DOS policy, you can choose either the first date or the last date to bill as the DOS, but do not break the service up into separate single exam codes.

For instance, if the patient is scheduled for a rest and stress myocardial perfusion scan with SPECT, and you choose to do the rest exam on Monday and the stress exam on Tuesday, you would bill the following code with either Monday’s or Tuesday’s date.

78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection


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