Stress Echo - billed in hospital

indirakumaris

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kindly confirm whether the below document for stress echo is eligble for 93320-26 and 93325-26 . It is billed in hospital.Doctor office bill for only 93350-26?

Indication: Chest pain

Measurements:

LA 3.7 cm

IVS 1.0 cm

PW 1.0 cm

LVEDD 4.2 cm

LVESD 2.7 cm

LVOT 2.0 cm

Ao 3.8 cm

2-D and Doppler interpretation:

The right atrium is normal. The tricuspid valve is morphologically normal. There is trace tricuspid regurgitation. The right ventricle appears normal in size and function. The pulmonic valve appears grossly normal. The left atrium is normal. The mitral valve is normal with normal leaflet excursion. There is trace mitral regurgitation. The left ventricular cavity size, wall thickness, and systolic function is normal. Left ventricular ejection fraction is estimated 55 %. The aortic valve appears normal with normal leaflet excursion. The proximal segment of the ascending aorta is normal in size. There is no pericardial effusion. The patient is noted to be in sinus rhythm during the study.

The patient exercised on a standard Bruce protocol, achieving greater than 85% of the maximal predicted heart rate with no chest pain reported, sinus rhythm throughout, no ischemic EKG changes, and physiologic blood pressure response.

STRESS ECHOcardiography revealed normal augmentation of left ventricular systolic function with EF 65% and no stress-induced ischemic wall motion abnormalities.

Conclusion:

Normal STRESS ECHOcardiogram

Thanks

indira.s
 

jewlz0879

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Doppler measures: intra-cardiac and/or pulmonary artery pressure; blood flow velocities; and cardiac valvular performance.

Color-flow: overall illustrationof blood flow obtained by doppler and identifies: septal defects, stenosis, regurgitation, insufficiency of cardiac valves, and shunts.

You can bill both 93320/93325.

Stress Echo in hosptial:
93350
93320 (when documented)
93325 (same as above)
93016
93018

Stress Echo in office:
93351
93320
93325

HTH
 

Jess1125

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I disagree, when you're doing all the professional components of both the stress test and stress echo, you should be billing 93351 with modifier -26 in the facility setting. Per CPT guidelines prior to the echo codes, "When only the professional components of a complete stress test and a stress echo are provided (eg, in a facility setting) by the same physician, use 93351 with modifier 26."

I would code
93351.26
93320.26
93325.26

It is my understanding that the 93350 is only to be used now if your physician wasn't doing all the professional services of the stress test such as only 93016 or only 93018.

Jessica CPC, CCC
 

jewlz0879

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Correct. As ours are not; we have one physician who does the stress portion 93016/93018 and another one the 93350-26/93320-26 and 93325-26. Otherwise, we would bill the way you have shown above.
 
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