Stress Less Over Coding Cardiac Stress Tests

Stress Less Over Coding Cardiac Stress Tests

Ask yourself: Did the cardiologist perform a complete cardiac stress test or just a component?

When your cardiologist performs a cardiac stress test using a submaximal or maximal treadmill, pharmacological stressor, or an exercise bike, you must check the medical documentation carefully for important details such as which components of the cardiac stress test your cardiologist performed. Additionally, if your cardiologist performs a stress echo with a stress test, you must follow specific rules when reporting these codes together.

Identify Complete Cardio Stress Test Code

Report 93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report when your cardiologist performs a complete cardiac stress test service. CPT® code 93015 is a global code, which includes the cardiologist’s supervision of the test; the supply of the equipment, tech, and electrocardiogram (ECG) tracing; and the cardiologist’s interpretation and report.

“Because code 93015 includes the technical component, supervision, and interpretation, this code is rightfully reportable only by a physician in a nonfacility setting (eg, office, clinic, or diagnostic testing center),” according to CPT® Assistant Vol. 20, No. 1. Also, it would only be appropriate to report 93015 if just one physician performs all three components of the service in a nonfacility setting.

Coding example: Your cardiologist, Dr. Overman, performed a maximal treadmill cardio stress test for a patient in his office. According to his medical documentation, Dr. Overman continuously monitored the patient’s heart rate, breathing, blood pressure, and level of tiredness during the procedure. Dr. Overman owns his equipment, employs the treadmill tech, and he provided his interpretation and report of the ECG data and the patient’s hemodynamics collected during the procedure. You would report 93015 for this scenario because one physician performed all three components of the 93015 cardiac stress test service in his office.

Rely on These Stress Test Component Codes

Now let’s say your cardiologist does not perform the entire 93015 service and, instead, only performs a portion of the service. In this case, you should turn to the following component codes:

For the professional component — the physician’s supervision of the cardiac stress test without interpretation or report — report:

93016   Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report

For the technical component — the cardiac stress test ECG tracing only — report:

93017              tracing only, without interpretation and report

This includes technicians’ work, providing the cardiac stress test equipment, and paying for the rental space, utilities, and supplies.

If your cardologist performs the interpretation and report portion of the professional component of the stress test, but does not supervise the test, use:

93018              interpretation and report only

If your cardiologist performs a cardiac stress test in a facility setting, such as a hospital, they should follow specific reporting rules. In this case, the hospital would report the technical component of the test (93017), and your cardiologist would report the appropriate code for the specific service they performed — 93016, 93018, or both — according to CPT® Assistant.

Coding example: Your cardiologist, Dr. Bell, performed an exercise bicycle stress test for a patient in the hospital. Dr. Bell performed the direct supervision of the stress test. Dr. Bell also performed the interpretation and provided a written report for the test findings. In this case, the hospital would report 93017 for the technical component since they own the stress test equipment. You would report 93016 for Dr. Bell’s direct supervision and 93018 for the interpretation of the test and written report.

Follow 5 Rules When Reporting Stress Echoes With Stress Tests

A cardiac stress test is one component of the stress echo. When performing a stress echo, the cardiologist will take echocardiographic images of the wall of the left heart before, after, and sometimes during the stress test to monitor the motion and thickening of specific walls, according to CPT® Assistant.

For stress echoes performed with cardiac stress tests, you can look to the following codes:

93350   Echocardiography, transthoracic, 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

Report code 93350 for “the performance and interpretation of a stress echocardiogram without all components of the stress testing (93015),” per CPT® Assistant.

93351             including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional

Report 93351 “when a physician performs the complete service of a stress echocardiogram combined with a complete cardiovascular stress test (continuous electrocardiographic monitoring, physician supervision, interpretation, and report) in a nonfacility setting,” according to CPT® Assistant.

When your cardiologist performs a stress echo along with a cardiac stress test, you must follow these rules to report the codes appropriately:

  • Rule 1: Report cardiac stress codes 93016–93018 in conjunction with code 93350 “to illustrate the cardiovascular stress portion of the study,” per CPT® guidelines.
  • Rule 2: Never report code 93350 with code 93015, according to CPT® guidelines.
  • Rule 3: Never report code 93351 with codes 93015–93018 or 93350.
  • Rule 4: Report code 93350 in either a nonfacility or facility setting.
  • Rule 5: Only report 93351 in a nonfacility setting.

If your cardiologist performs doppler and color flow studies, you can separately report these services if performed with the stress echo. In addition to the stress echo code, you may report +93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete or +93321 … follow-up or limited study (List separately in addition to codes for echocardiographic imaging and +93325 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) if the medical documentation supports it.

Meagan Williford, MA, CPC-A
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Meagan Williford, BA, MA, CPC-A, is the development editor for TCI’s newsletters Cardiology Coding Alert, Podiatry Coding and Billing Alert, and Neurosurgery Coding Alert.

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