Cardiology Coding Alert

Hint: You can only report code 93015 in a nonfacility setting.

Cardiac stress test claims can be tricky because CPT^® has so many rules for appropriate reporting these services. For example, you must know if your cardiologist performed the complete stress test service or just a component. You must also know which codes you can report in a facility versus a nonfacility setting.

Shatter the following myths to ensure you always submit clean cardiac stress test claims.

Myth 1: Your Cardiologist Will Only Refer to the Stress Test in One Way

Reality: When you check the medical documentation, you can find several different ways your cardiologist may refer to a stress test. These include cardiac stress test, cardiovascular stress test, exercise stress test, exercise treadmill test, exercise tolerance test, stress test, exercise electrocardiogram (ECG) test, pharmacologic stress test, or drug infusion stress test, per CPT^® Assistant Vol. 20, No. 1.

Myth 2: Code 93015 is Component Code

Reality: Code 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report) is the complete cardiac stress test. You should report this global code when your cardiologist performs a complete cardiac stress test service.

Code 93015 includes your cardiologist’s supervision of the stress test, the supply of the equipment, tech, and ECG tracing, and the cardiologist’s interpretation and report.

Don’t miss: CPT^® has strict rules about the place of service (POS) where your cardiologist can report 93015. “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.

Myth 3: Only 1 Provider Can Report Codes 93016-93018

Reality: When just one provider does not perform the complete stress test procedure (93015), the various providers involved should report the following component codes, depending upon which portion of the service they performed, according to CPT^® Assistant:

• 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). This is a professional component of the cardiac stress test. Report code 93016 for the physician’s supervision only.
• 93017 (… tracing only, without interpretation and report). This is the technical component of the cardiac stress test. Report code 93017 for the ECG tracing only. This component includes technicians, providing the cardiac stress test equipment, paying for the rental space, utilities, and supplies.
• 93018 (... interpretation and report only). This is a professional component of the stress test. Report code 93018 for the physician’s interpretation and written report only.

Don’t miss: If your cardiologist performs a cardiac stress test in a facility setting such as a hospital, he 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 he performed — either 93016, 93018, or both codes, according to CPT^® Assistant.

“Often times a non-physician provider (NPP) will perform the supervision of the test in a hospital setting and the physician will provide the interpretation and report,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. “In this case, the NPP should bill 93016 for their supervision, and the provider should bill 93018 for their interpretation and report. Both should have documentation for their part of the service.”

Myth #4: Your Cardiologist Will Never Report Stress Echo With Stress Test

Reality: Your cardiologist may perform a stress echo with a stress test. When your cardiologist performs a stress echo, he 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.

You have several codes to look to when your cardiologist performs a stress echo with a stress test. They include the following:

• 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;) Remember: You should 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) Remember: You should 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.

Myth #5: CPT^® Doesn’t Offer Special Rules for Reporting Stress Echoes With Stress Tests

Reality: CPT^® offers numerous rules you must follow when reporting a stress echo along with a cardiac stress test.

For example, you can report cardiac stress codes 93016-93018 in conjunction with code 93350 “to illustrate the cardiovascular stress portion of the study,” per the CPT^® guidelines.

Also, you should never report code 93350 together with code 93015, according to the guidelines.

You should never report code 93351 with codes 93015-93018 or 93350.

You can report code 93350 in either a nonfacility or facility setting.

Finally, you should only report 93351 in a nonfacility setting.

Remember: “Don’t forget to look for add-on codes performed along with the stress echo including +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete)), +93325 (Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography), and +93356 (Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging)), if documented within the report,” Peterson says. “You will need to append the modifier 26 (Professional component) to codes +93320 and +93325 if they were performed in a facility setting.”