Cardiology Coding Alert

Question: What code should I append a modifier to if the cardiologist performed an electrocardiogram (EKG) with an office visit and decided to do the stress echo that day as well, based on the EKG findings?
      
Colorado Subscriber

Answer: You should add modifier -59 (Distinct procedural service) to 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) for EKG to show that this was progressive testing (that is, the EKG led to the stress test) rather than intrastress test monitoring. The National Correct Coding Initiative bundles the EKG into the stress test, but the edit has an indicator of "1," meaning that a modifier will circumvent the edit and allow payment. In this instance, the most appropriate modifier is -59. You should not bill separately (with or without modifier -59) for the EKG the physician performs as a routine portion of a planned stress test.