Cardiology Coding Alert

Question: According to the CPT^® guidelines for 93350, “When only the professional components of a complete stress test and a stress echocardiogram are provided (eg, in a facility setting) by the same physician, use 93351 with modifier 26.” But, in the article in Cardiology Coding Alert Vol. 20, No. 7 from May 2017, “5 Steps Will Simplify How You Report Stress Echoes with Stress Tests,” it says, “You should only report 93351 in a non-facility setting, according to CPT^® Assistant.” Please clarify this. Can 93351 be billed in a facility setting or not?

Florida Subscriber

Answer: In 2018, there was clarification on how to appropriately code 93350 and 93351, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Codes 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 supervision by a physician or other qualified health care professional) and facility HCPCS code C8930 (Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, 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) combined stress testing with echocardiography. The American Hospital Association has advised that hospitals should use the combined codes and not report the echocardiogram and stress test separately.

AMA CPT^® specifically states not to report 93351 in conjunction with 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report) through 93018 (… interpretation and report only) and 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). You should also not report 93351–26 (Professional component) in conjunction with codes 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) 93018, and 93350-26.

AMA CPT^® also states that when only the professional components of a complete stress test and a stress echocardiogram are provided by the same physician, you should report 93351 with modifier 26. When all professional services of a stress test are not performed by the same physician performing the stress echocardiogram, you should report 93350 in conjunction with the appropriate codes (93016-93018) for the components of the cardiovascular stress test that are provided.

Also, The American Society of Echocardiograms recommends that a stress echocardiogram include at least an assessment of the regional and global left ventricle function both at rest and at stress.

Bonus tip: Code +93352 (Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)) is for physician use only. Use code 93352 administration of contrast during stress echocardiograms. Hospitals report the contrast administered with the appropriate HCPCS contrast Q-code. Physician payment for the HCPCS Q-code is dependent on the payer’s discretion. This is only reported by who purchases the contrast. Remember: The physician must purchase the contrast to report the Q-code. And, 93350 through 93351 are now directed according to the number of physicians providing the service.

Don’t Forget: Doppler codes +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete) or +93321 (… follow-up or limited study (List separately in addition to codes for echocardiographic imaging)) and Doppler color flow velocity mapping +93325 (Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)) are add-on codes and, if documented, should be reported in addition to the appropriate echocardiogram codes.