Cardiology Coding Alert

Question: Our cardiologist performed a stress test on the treadmill, but we do not own the treadmill. Can we report 93015-26 for this service?


Kansas Subscriber


Answer: You should not use modifier 26 (Professional component) for this service. You can report 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) with no modifiers appended if the physician performed all components of the code. In other words, clinic staff performs the test in the cardiology clinic, and your physician interprets the test. 

If the cardiologist performs the test elsewhere, you must unbundle the code in one of the following ways:

• Report 93016 (... physician supervision only, without interpretation and report) if the physician provides the necessary "general" supervision of the diagnostic test. More specifically, he was in the facility when the test occurred.

• Report 93018 (... interpretation and report only) if the physician performs the interpretation and report of the diagnostic test data.

• Report 93016 and 93018 if the physician performs both the supervision and the interpretation and report but he did not perform the test in his clinic. This is often the proper way to bill for stress tests performed in a hospital setting.

The hospital or other owner of the test equipment will report 93017 (... tracing only, without interpretation and report) to collect its share of reimbursement.

Although you are normally correct to use modifier 26 to separate out the professional component of a global code, using modifier 26 on 93015 would be inappropriate because the above codes better describe the physician's work supervising and interpreting the tests.