Ask Dr. Z

Our physicians order a nuclear stress test, and a pharmaceutical or treadmill stress is performed first. In the documentation the stress test is terminated either with accompanying symptoms (e.g., chest pain or SOB) or no accompanying symptoms. The nuclear imaging is then performed. The codes they include are 78452, 93016, and 93018. Are codes 93016 and 93018 still appropriate since the stress was terminated? Do we append modifier -53 if the termination was per protocol, but with accompanying symptoms, which would put the patient at risk if the stress was continued? If the patient has no symptoms documented during the stress protocol, should codes 93016 and 93018 be billed at all?