Modifier Coding Alert

Published on Thu Feb 27, 2014 PDF

Question: Which modifier can I use when billing 93010, 93016, 93018, and 78452?

Medicare denied 93010, 93016, and 93018 because, the procedure or the procedure with a modifier are not compatible.

Illinois Subscriber

Answer: You can’t report 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) and 93018 (... interpretation and report only) together. There’s a combined CPT® code to report all three components of a cardiovascular stress test: 93015 (... with supervision, interpretation and report).

The CPT® codes that you should use are:

• 78452-TC (Myocardial perfusion imaging, tomographic [SPECT] [including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed]; multiple studies, at rest and/or stress [exercise or pharmacologic] and/or redistribution and/or rest reinjection) for the imaging. Add modifier TC (Technical component) to show that your provider performed the report and interpretation but does not own the equipment.
• 93015 for the stress test
• 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) with modifier 59 (Distinct procedural service) for the ECG. Attach modifier 59 to 93010 to break the bundle between 93010 and 93015.

Tip: Code 93015 is the global cardiac stress test code that encompasses the entire stress test: equipment, physician supervision, and interpretation and report (I&R).

If your physician does not perform all three components, you should report the specific component code (93016-93018) that represents the physician’s role rather than using modifiers 26 (Professional component) or TC on 93015.