Clean Up Your Cardiovascular Stress Test Coding with MPFS Insights
Depending on your sense of humor, focusing on the topic of stress tests during the last two crazy weeks of the year might just make you smile. Or groan. Either way, if you code cardiovascular stress tests, you may find some useful hints in today’s post.
Start With Stress Test Codes 93015–93018
Codes 93015–93018 are the backbone of cardiovascular stress test coding.
All of their descriptors start with the same wording: “Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress.”
In other words, an ECG monitors the patient to see how she responds when the cardiovascular system is stressed. The stress comes either from exercise (treadmill or bike) or, if exercise is not appropriate for the patient, from the introduction of a pharmacological agent.
Bump Up Your MPFS Savvy With Stress Test Tip
These stress test codes are an interesting bunch because they have a structure that you won’t see with many other codes. One of the codes, 93015, describes the global service. Each of the other codes represents a component of the global service.
In other words, if you aren’t reporting the global service, you should not report global code 93015. You should report the appropriate component code(s). You should NOT use modifier 26 Professional component or TC Technical component on these codes.
The PC/TC indicators on the Medicare Physician Fee Schedule (MPFS) back this up. If you haven’t looked at PC/TC indicator definitions before, it’s definitely worthwhile as it offers a sense of how Medicare values each service. Below each code below is the PC/TC indicator with definition from Medicare.
- 93015: Whole shebang of ECG tracing, supervision, and interpretation with report
- PC/TC indicator: 4 = Global Test Only Codes. This indicator identifies stand-alone codes that describe selected diagnostic tests for which there are associated codes that describe (a) the professional component of the test only, and (b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. The total RVUs for global procedure only codes include values for physician work, practice expense, and malpractice expense. The total RVUs for global procedure only codes equals the sum of the total RVUs for the professional and technical components only codes combined.
- 93016: Supervision only
- PC/TC indicator: 2 = Professional Component Only Codes. This indicator identifies stand-alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the technical component of the diagnostic test only and another associated code that describes the global test. An example of a professional component only code is CPT® code 93010 – Electrocardiogram; Interpretation and Report. Modifiers 26 and TC cannot be used with these codes. The total RVUs for professional component only codes include values for physician work, practice expense, and malpractice expense.
- 93017: Tracing only
- PC/TC indicator: 3 = Technical Component Only Codes. This indicator identifies stand-alone codes that describe the technical component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic test only. An example of a technical component only code is CPT® code 93005 – Electrocardiogram; Tracing Only, without interpretation and report. It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code. Modifiers 26 and TC cannot be used with these codes. The total RVUs for technical component only codes include values for practice expense and malpractice expense only.
- 93018: Interpretation and report only
- PC/TC indicator: 2 = Professional Component Only Codes. (See 93016 above for full definition.)
Watch Out for Variations
There are times when reporting a code from 93015–93018 is not enough to describe the full service and even times when reporting one of those codes is plain wrong for a cardiovascular stress test. Keep an eye out for these situations.
Radioisotopes and stress agents: If your practice bears the costs of agents used during the testing, be sure to report them using the appropriate HCPCS codes, such as A9500 Technetium Tc-99m sestamibi, diagnostic, per study dose and J0153 Injection, adenosine, 1 mg [not to be used to report any adenosine phosphate compounds]. Let the documentation be your guide, as always.
MPI: If the test involves myocardial perfusion imaging MPI, choose from 78451–78454.
Stress echo: For a complete stress echo, report 93351 Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, during rest and cardiovascular stress test …. When you use 93351, you should not additionally report a code from 93015 to 93018.
But if you’re using one or more component codes from 93016 to 93018, then you should report the echo using 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.
Caution: Reporting a stress echo performed in a facility setting can be confusing. If you’re submitting a stress echo claim for a physician who performed all the professional components of the stress echo in a facility, then you should submit complete stress echo code 93351 with modifier 26 appended. There was a lack of clarity on this point when the codes first came out, with differences between Medicare and CPT® rules, but eventually both side landed on the rule that 93351-26 is an appropriate option.
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