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Stress Echo Codes

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    So we can bill 93351-26 in the outpatient/inpatient hospital setting. Thanks

  2. #12
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    Quote Originally Posted by peeya View Post
    So we can bill 93351-26 in the outpatient/inpatient hospital setting. Thanks
    Yes, I do it all the time for some of the outpatient ones. (Don't ask, it's a complicated situation!)

    Jessica CPC, CCC

  3. Smile E&M with modifier 25 and stress echo in the office
    Good evening to all, I am also a rookie biller by necessity, 2 commerical carriers have denied the EKG and not sure if the 59 should be used with the stress echo. I have to appeal the claim, has any one seen denials ?

  4. #14
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    Kansas City, MO
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    Quote Originally Posted by cardiorookie View Post
    Good evening to all, I am also a rookie biller by necessity, 2 commerical carriers have denied the EKG and not sure if the 59 should be used with the stress echo. I have to appeal the claim, has any one seen denials ?
    I just want to clarify....when you say EKG do you mean the 93000, 93005, 93010 codes or do you mean the 93015, 93017, 93016, 93018 codes? I know it may sound like a silly question to some, but I've had people call the stress test portion an EKG so I thought I would check.
    Olivia Price, CPC, CCC
    Physician Coder Supervisor
    The University of Kansas Health System

  5. #15
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    Per CMS Transmittal 1810 it was clarified "that CPT code 93351 (26) is payable when performed by a physician in a facility setting". I would assume since the code includes both the echo and stress test portions that when billing with the 26 modifier that is saying only the professional portions of the stress test (represented by 93016 & 93018) were done by the physician. Per the ASE (American Society of Echocardiography) FAQs in their December 2009 Coding and Reimbursement Newsletter, the difference between 93350 and 93351 is that "93351 combines the stress test with a stress echo. It is reported when one physician does both the stress test and stress echo. 93350 is a stress echo code that doesn't include the stres test. When one physician performs the echo portion, and another physician performs the stress test, each physician reports his service as applicable with codes 93350 and the relevant stress test codes (93015-93018)." And also states "Code 93351 is intended for use when the physician performs the services of both the stress echo and the stress test in any setting. CMS has clarified that code 93351 is payable when provided by a physician in a facility setting. Modifier 26 should be added to designated the physician service." (A bit of history...when the code 93351 was first added to CPT in January 2009 it did NOT have a PC/TC split and instruction at that time was to only use it in an office setting where the physician owns the equipment and employs the technician. CMS's Transmittal 1810 in September 2009 changed this, back-dating the effective date to January 1, 2009.)

    My question is whether 93351-26 should be used if only the interp/report portion (93018) of the stress test was done by the physician (in addition to the stress echo), if the physician interpreting and reporting did not personally supervise the stress test or if 93350-26 and 93018 should be used instead?

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