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Scenario Week of March 16, 2010:
View Current Scenario

Diagnosis: Chest pain
Final Diagnosis: Unspecified chest pain

A 72-year-old male Medicare patient presents to the outpatient radiology department for a cardiac transthoracic echo with treadmill exercise stress.

An IV was started and the patient started running on the treadmill. Exercise duration 8 minutes 41 seconds.

Patient was given 10 microliters of Definity by IV push.

Baseline HR: 67, Max HR: 144, Predicted HR: 150, Percent of predicted HR: 96%
Baseline BP: 145/82, Max BP: 168/64, Exercise duration: 8:41 min
Mets: 10.1

Exam Description
The stress echocardiography was performed immediately post treadmill exercises. Definity contrast was used to enhance image quality. Image quality was good. The patient tolerated the procedure well.

Physician review and assessment

Left ventricular size is normal. Global left ventricular systolic function is normal (EF 55-70%). Left ventricular segmental wall motion is normal.

No mitral regurgitation seen. Mild aortic insufficiency is present.

The baseline rhythm was sinus. Left axis deviation is present. There were no arrhythmias. ST segments and T waves are normal at baseline.

This primary reason for test termination was fatigue. The patient experienced atypical chest pain. No ST-T changes developed. Sinus tachycardia was noted. There were no arrhythmias. Global left ventricular function increased appropriately with stress. No new regional wall motion abnormalities were seen.

No ST-T changes developed. Heart rate recovery at 1 minute into cool down period was abnormal (<12 bpm), suggesting a less favorable prognosis.

Normal LV systolic function (EF 55-75%). Atypical chest pain during stress was noted. Heart rate recovery at 1 minute into cool down period was abnormal (<12 bpm), suggesting a less favorable prognosis. The patient’s stress tolerance was fair. Symptoms not suggestive of ischemia. Echo not suggestive of ischemia. Low probability of myocardial ischemia based on this test alone.

Assign the appropriate CPT, HCPCS, and ICD-9 codes for this OPPS hospital.


C8928Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report
Q9957Injection, perflutren lipid microspheres, per ml

CPT Code
93017Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report

ICD-9 Code
786.50Chest pain, unspecified

CMS has instructed hospitals to use the appropriate HCPCS code for echocardiograms performed with contrast. The contrast material should be reported separately. It is not appropriate to report the IV push of the contrast material. The IV push is included in the procedure.

The physician has not provided a more specific diagnosis than chest pain.

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