# Stress echos performed in a hospital setting



## daradare (Sep 12, 2016)

I am trying to verify stress echo coding for both the providers' and hospital's billing done in a hospital outpatient setting.  I have the provider billing as 93350-26, 93016 and 93018.  With the hospital billing 93350-TC and 93017.

Also, if done in an office setting, 93351 globally?

Can anyone verify if this is correct?

Thanks for your help.


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## cpc2007 (Sep 15, 2016)

Hi , for a physician providing supervision & interpretation for a stress echo/stress test in a hospital setting, the 2016 CPT guidelines state that if the same physician is performing all of the professional components of the stress test and the stress echo (eg, in a facility setting), code CPT 93351 with modifier 26.  However, when all of the professional components of the stress test are not performed by the same physician performing the stress echocardiogram, you would report 93350.26 plus 93016 or 93018 to represent the professional component performed by that physician.  As an example, physician A interprets the stress echo and the stress test but physician B provided the direct supervision for the stress test.  In that example, physician A would report 93350.26 and 93018 and physician B would report 93016.

I agree that if the stress echo and stress test were performed in an office setting where the provider you are billing for owns/leases the office space and equipment and incurs the cost of hiring staff and providing supplies which entitles him to code the global service that you would report 93351 globally (no modifier).  I hope that helps!


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## jbassett1 (Sep 17, 2016)

The way I understand 93351-26 is if the *same *physician performs all 3 components of 93350 + 93016 + 93018 then you can report 93351-26 instead of each of the previous codes.   But, if one physician does 93350 and another does the 93016 & 93018 then you can't use 93351.

I don't code for hospitals but what you mentioned 93350-TC and 93017 seems correct.






daradare said:


> I am trying to verify stress echo coding for both the providers' and hospital's billing done in a hospital outpatient setting.  I have the provider billing as 93350-26, 93016 and 93018.  With the hospital billing 93350-TC and 93017.
> 
> Also, if done in an office setting, 93351 globally?
> 
> ...


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## danskangel313 (Sep 17, 2016)

Here are the codes and guidelines:

*93350* 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 [this is a global service] 
(Stress testing codes 93016-93018 should be reported, when appropriate, in conjunction with 93350 to capture the cardiovascular stress portion of the study) 
(Do not report 93350 in conjunction with 93015)

*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 supervision by a physician or other qualified health care professional [this is a global service]
(Do not report 93351 in conjunction with 93015-93018, 93350. Do not report 93351-26 in conjunction with 93016, 93018, 93350-26)

*93015 *Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report [this is a global service] 

*93016 *Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report [professional component only] <-- no modifier should be applied 
Code 93018 represents the professional component of the service only, so you should not append modifier 26, Professional component, or TC, Technical component. To report the technical component only, the rendering provider should report 93017.

*93018 *Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only [professional component only] <-- no modifier should be applied 
Code 93018 represents the professional component of the service only, so you should not append modifier 26, Professional component, or TC, Technical component. To report the technical component only, the rendering provider should report 93017.

*93017 *Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report [technical component only] <-- no modifier should be applied 
Code 93017 represents the technical component of the service only, so you should not append modifier 26, Professional component, or TC, Technical component... 

To report the professional component only, the rendering provider should report _93016_, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and or pharmacological stress, supervision only, without interpretation and report, or _93018_, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and or pharmacological stress, interpretation and report only...

To report both the technical and professional components, the single rendering provider should report 93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and or pharmacological stress, with supervision, interpretation and report.


In the original question, here's how it would be billed.
(when done in a facility) The physician should be reporting 93350-26, 93016 or 93018. The facility should be reporting 93350-TC and 93017. 

If the provider owned the equipment (in the office), then you would bill 93351 (NO MOD).


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