Cardiology Coding Alert

Question: I am questioning how to code stress echos on patients that are done in the hospital when the cardiologist does the interpretation and supervision. I read that for Medicare patients we should bill 93351-26 and for non- Medicare payers we should bill 93350-26, 93016, and 93018. Is this information correct?

Codify Member

Answer: You are correct about the coding for a Medicare patient. A full stress test and echocardiography are included in 93351 (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; including performance of continuous electrocardiographic monitoring, with physician supervision).

When 93351 became a valid code on Jan. 1, 2009, Medicare did not give it professional or technical components. It seemed to apply only to the full stress test plus the stress echo. Several months later, Medicare created separate professional and technical components for 93351, and following that the agency clarified that  "93351 (26) is payable when performed by a physician in a facility setting" (www.cms.gov/MLNMattersArticles/downloads/MM6617.pdf).

The code has a PC/TC indicator of "1" on the Medicare physician fee schedule, meaning that you may use modifier 26 (Professional component) and modifier TC (Technical component) with the code.

How you report the physician's portion of a stress echo to a private payer will depend on that payer's preferences, so be sure to get them in writing. For those payers who have not split 93351 into professional and technical components, the codes you describe may be correct, depending on the documentation:

• 93350-26, Echocardiography, transthoracic, realtime with image documentation (2D), includes Mmode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report
• 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
• 93018, ... interpretation and report only.

Payers may follow CPT® Assistant (Jan. 2010) which says 93351 is limited to when you're reporting a full stress test plus the full echo in a non-facility setting.