Cardiology Coding Alert

Answer: The stress echo combines two separate services a stress test and an echocardiogram says Martha Gerant, CPC, a coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan. Code 93350 (echocardiography, transthoracic, real-time with image documentation [2D], with or without M-mode recording, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report) is used to report the echocardiogram portion of the service. CPT also specifies, The appropriate stress testing code from the 93015-93018 series should be reported in addition to 93350 to capture the exercise stress portion of the study.

In this case, because the stress echo was performed in the hospital, 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) and 93018 (. . . interpretation and report only) should be used. Code 93350 should also be appended with modifier -26 (professional component) to indicate that the service took place in the hospital (i.e., the cardiologist does not own the testing equipment). Modifier -26 should not be appended to either 93016 or 93018, however, because both codes already describe only the professional component of the stress test.

If doppler and color flow are performed, codes 93320 (doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete) and 93325 (doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]) may also be billed. Both codes should be appended with modifier -26.