Relevant Codes for Lexiscan® (regadenoson) injection

Properly coding claims will help facilitate timely claims processing and reduce the risk of denied claims. Coding requirements vary by payer.1 The coding systems in the following tables will assist you in proper coding for Lexiscana:

Code Code Description Notes
00469-6501-05 0.4 mg/5 mL single-use vial Packaged individually
00469-6501-89 0.4 mg/5 mL single-use prefilled syringe
Code Code Description
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I20.9 Angina pectoris, unspecified
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2 Old myocardial infarction
I25.6 Silent myocardial ischemia
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 Chronic total occlusion of coronary artery
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I70.8 Atherosclerosis of other arteries
I70.90 Unspecified atherosclerosis
I70.91 Generalized atherosclerosis
R07.1 Chest pain on breathing
R07.2 Precordial pain
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R94.30 Abnormal result of cardiovascular function study, unspecified
R94.31 Abnormal electrocardiogram [ECG] [EKG]
R94.39 Abnormal result of other cardiovascular function study
Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system
Code Code Description
3E033HZ Introduction of Radioactive Substance into Peripheral Vein, Percutaneous Approach
4A12XM4 Monitoring of Cardiac Stress, External Approach
C2161ZZ Planar Nuclear Medicine Imaging of Right and Left Heart using Technetium 99m (Tc-99m)
C216YZZ Planar Nuclear Medicine Imaging of Right and Left Heart using Other Radionuclide
C21G1ZZ Planar Nuclear Medicine Imaging of Myocardium using Technetium 99m (Tc-99m)
C21GDZZ Planar Nuclear Medicine Imaging of Myocardium using Indium 111 (In-111)
C21GSZZ Planar Nuclear Medicine Imaging of Myocardium using Thallium 201 (Tl-201)
C21GYZZ Planar Nuclear Medicine Imaging of Myocardium using Other Radionuclide
C21GZZZ Planar Nuclear Medicine Imaging of Myocardium
C21YYZZ Planar Nuclear Medicine Imaging of Heart using Other Radionuclide
Code Code Description Notes
0250 Pharmacy-General (Inpatient use only) Some payers, such as Medicare, require certain combinations of revenue codes and HCPCS or CPTb codes to facilitate claims processing. Confirm requirements with local payer policies.
0343 Nuclear medicine, diagnostic radiopharmaceuticals
0482 Cardiology-Stress Test
0636 Drugs requiring detailed coding
Code Code Description Notes
J2785 Regadenoson, 0.1 mg

This code represents a partial vial of regadenoson. Report the appropriate number of units based on amount of drug provided to the patient.

Note: Although Medicare does not pay for Lexiscan separately in the hospital outpatient department setting, it is important that providers continue to report HCPCS codes for all products and services provided to the patient.

Code Code Description Notes
NUCLEAR MEDICINE IMAGING
78451 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); single study, at rest or stress (exercise or pharmacologic) This series of CPT codes are for the nuclear medicine myocardial perfusion study. Assign the appropriate code(s) for the service provided.
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
78453 Myocardial perfusion imaging, planar (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
78454 Myocardial perfusion imaging, planar (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
STRESS TEST
93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report This series of CPT codes are for the stress test performed in conjunction with the nuclear medicine myocardial perfusion study. Pick the appropriate code for the service provided.
93016 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report
93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation or report
93018 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only

a IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims conforming to the requirements of the relevant payer for those products and services rendered. Pharmacies (or any other provider submitting a claim) should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by Lexiscan Support Solutions are to assist providers and pharmacies, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider and pharmacy, and information provided by Lexiscan Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.

b Current Procedural Terminology (CPT), Professional Edition, 2016. American Medical Association, 2015. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no responsibility for the data contained herein. CPT is a registered trademark of the American Medical Association.

References

1. Beck DE, Margolin DA. Physician coding requirement. Ochsner J. 2007;7:8-15.

2. Centers for Medicare & Medicaid Services. 2017 ICD-10-CM and GEMs. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. Accessed 12-07-2016.

3. Centers for Medicare & Medicaid Services. 2017 ICD-10-PCS and GEMS. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html. Accessed 12-07-2016.

4. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending. Accessed 12-06-2016.