Cardiology Coding Alert

Question: Is it possible to report a stress test and ECG for the same date of service?

Answer: Reporting a stress test and ECG on the same date is possible, but it isn't always correct. Codes 93015-93018 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress ...) specify "continuous electrocardiography monitoring," so if the ECG is related to the stress test, you should not report the ECG separately. You may consider reporting the ECG when it is unrelated to the stress test.

Supporting example: Correct Coding Initiative (CCI) edits bundle 93040 (Rhythm ECG, one to three leads; with interpretation and report) into 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report). The edit has a modifier indicator of 1, which means you may override the edit when clinically appropriate.

According to CMS's "Modifier -59 Article," using modifier 59 (Distinct procedural service) to override the edit is "only appropriate if the rhythm ECG service 93040 is performed unrelated to the cardiovascular stress test procedure at a different patient encounter."

You'll find CMS's modifier 59 article online at www.cms.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf, or scroll down on the following site to find the link: www.cms.gov/NationalCorrectCodInitEd/.