I agree with the way you would code this for the reason above from Medicare policy. I would code it 93350.26, 93016, and 93018. If the doppler/color flow is documented as it is above, then I would bill those out in addition to 93350.26.Hello,
I have been a certified coder for 6 years now but am starting new in the Cardiology Specialty and am having a little trouble with how to code Stress Echos. We send out some of our procedures to a contract coder and I am not sure I agree with how these are being coded. Here is a sample documentation.
The left ventricular chamber size is normal. Mild concentric left bentricular hypertrophy is observed. There is normal left ventricular systolic function. Ejection fraction estimated at 55-60%. Normal left ventricular diastolic filling is observed.
The left atrium is mildly dilated.
The right bentricular cavity size is normal. The right ventricular global systolic function is normal.
The right atrial cavity size is normal.
There is no dilation of the aortic root. There is no aortic valve stenosis. There is no aortic regurgitation. There is a trace amount of aortic valve regurgitation.
The mitral valve leaflets are mildly thickened. There is no mitral valve stenosis. There is mild mitral valve regurgitation observed.
The tricuspid valve leaflets are mildly thickened. There is trace tricuspid valve regurgitation present.
There is no pulmonic valve stenosis present. There is no pulmonic regurgitation.
There is no pericardial effusion.
There is no dilatation of the ascending aorta.
Unable to detect peak tricuspid regurgitant velocity for pulmonary artery systolic pressure calculation.
The venous system is not well visulalized.
The technical quality of this study is adequte. This echocardiogram was performed using 2D, m-mode, color and spectral Doppler.
Patient EKG is normal. but there is 1mm J-point elevation throughout at rest. Patient exercised for 12 minutes and 45 seconds, achieving a peak heart rate of 161bpm, which is 92% MPHR. He also achieved a double product of 26,000. At peak stress there is 1mm Upsloping ST depression at peak which resolved by one minute in recovery. Impression: Negative Stress ECG.
Impression: Negitive Stress ECG.
Impression: Negative Echocardiographic Stress Test.
Patient's resting EKG shows 1mm J-point elevation throughout at rest (Renomalization abnormalities). Patient exercised for 12 and 45 seconds, achieving a peak heart rate of 161bpm, which is 92% MPHR. He also achieved a double product of 26,000. At peak stress there is 1mm Upsloping ST depression at peak which resolved by one minute in recovery.
Echocardiographic images obtained at rest and exercise show generalized improved regional wall motion throughout as well as a decrease in size of the LV chamber dimension.
We bill only the professional component as we do this test in the Outpatient department of our hospital.
I think this should be coded as follows:
93350-26 / 93320-26 / 93325-26 /93016 / 93018
The Contract Coder says it should be billed as:
93350-26 / 93016 / 93018 / 93306-26/59
I do not agree with billing the 93306 with the Stress Echo 93350 because I found the following statement on the Medicare Website: "It is medically inappropriate, and contradicts CPT descriptors, to submit CPT 93306, 93307 or 93308, preformed in conjunction with CPT 93350, as 93350 includes a 93306, 93307 or 93308 service."
( http://www.cms.gov/medicare-coverage...g_10012010.pdf )
Does anyone know of any other resources that would state you could bill the 93306? or is there an experienced cardiology coder out there who can explain to me why this would be correct or incorrect?
Any imput is greatly appreciated. Thanks much
Jessica CPC, CCC
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