# Same day stress echo/echo doppler considered inclusive



## Pillow1 (Jun 9, 2010)

Can anyone advise if a stress echo and an echo doppler cannot be performed on the same day.  Medicare processed the following three lines of service and denied the echo as inclusive.  I am thankful to receive  any feedback.  Thanks  

   05/07/10          93351-26 59-stress echo            co-45
   05/07/10          93306-26    -echo doppler           co-97
   05/07/10          99222-25    -hospital inpatien    co-45


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## CHaslam (Jun 9, 2010)

They could be done on the same day but -59 modifier would need to be attached and an explanation why it was necessary to do both procedures stated in the note.


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## Pillow1 (Jun 9, 2010)

Ok then thank you, i just didn't know if a 59 modifier could attach to the echo doppler (93306 26 59) in addition to the already billed  stress echo  93351 26 59 (billed with a modifier 59 on this procedure already) and it was paid by medicare  ..thank you very kindly


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## sbicknell (Jun 9, 2010)

It is going to come down to medical necessity. You are going to have to appeal this with both reports and supporting letter/documentation. There should be 2 separate interp and reports to clearly show these were 2 separate tests. 

Since you already coded/billed with a -59 on the 93351 it won't do any good to add a -59 on the 93306.  It's redundant, meaning.......

93351-26-59 with 93306-26 says: the 93351 is separate from the 93306
93351-26-59 with 93306-26-59 says: the 93351 is separate from the 93306 and the 93306 is separate from the 93351 (huh??)

Assuming he ordered these tests, he has to show 2 points:
1) that based on the findings of the 93306, the decision was made to do the 93351.
2) that the results of the 93306 were insufficient for use as part of 93351

Basically the 93306 is a rest study and the 93351 is a rest and stress study. He has to show he is not duplicating his serivce. What's his reports show and what DX were reported? For example:

93306-26
Indication for test: SOB
Results/findings: abnormal with decreased function 

93351-26-29
Indication for test: abnormal echo
Results/findings: M and A valve regurg with EF 34%


_93306  Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 

93351  Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision _


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## Pillow1 (Jun 10, 2010)

Perfect, thank you for the clarification.  That makes sense.


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## balloju (Feb 19, 2013)

*Indication for 93351*



pillow1 said:


> perfect, thank you for the clarification.  That makes sense.



i have a ? 
When i sent a cliam with icd9cm as--794.30 and 272.4 for 93351, it got rejected by medicare and said as there is no proper indication, medicare doesnt want to pay. 
Can any body tell me where it is wrong.


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