Internal Medicine Coding Alert

Published on Wed Sep 06, 2006 PDF

Question: Our internist 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. Here is a breakdown of stress test coding:

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, the internist must own the stress-test equipment and the test must be performed on this equipment.

If the physician does not own the equipment, the code must be unbundled in one of the following ways:

• Report 93016 (... physician supervision only, without interpretation and report) if the physician was physically present at the time of the test to supervise.

• Use 93018 (... interpretation and report only) if the physician performed the interpretation and report.

• Report 93016 and 93018 if the physician performed both the supervision and the interpretation and report but does not own the equipment.

• 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 it is 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/interpreting the tests.