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Practice Management Alert

Reader Question:

Avoid Modifier -26 With 93015

Published on Mon Nov 17, 2003

Question: Would you explain when it is appropriate to use 93015 and when it would be better to bill 93016 and 93018?

Texas Subscriber

Answer: Billing global code 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) is the right choice "when all components of the code are performed by a single entity," including use of test equipment and physician supervision, interpretation and report, says Kathy Pride, CPC, CCS-P, with QuadraMed in San Rafael, Calif. But, she says, the physician must own the  stress-test equipment and the test must be performed on this equipment.
 
If the physician does not own the equipment and/or sends the patient to a hospital for the test, the code must be unbundled in one of the following ways:
 

  •  use 93016 if the physician was physically present at the time of the test to provide supervision
     
  •  use 93018 if the physician performed the interpretation and report
     
  •  use 93016 and 93018 if the physician performed BOTH the supervision and the interpretation and report
     
  •  93017 is for the hospital or other owner of the test equipment to use to get their share of reimbursement.
     
    Modifier -26 (Professional component) is partly to blame for any confusion with these codes. Whereas it is correct to use -26 to separate out the professional component of a global code, "using modifier -26 on 93015 would be inappropriate because there are codes that are specific to the professional component (93016 and 93018)," Pride says.

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