# Second Request: Stress Echo w/ Modifier 53



## laurap (Nov 2, 2009)

*Second Request: Please Help!*

We have a patient that was seen in the outpatient setting for an Exercise Stress Echo Study. The study was not completed.

This is what the summary on the report looks like:

_"A stress echocardiographic study was initially scheduled today to assess chest pain symptom and exclude residual myocardial ischemia in a patient with known coronary artery disease, status post MI and prior stent placement. The resting images were obtained and found to be technically inadequate, and contrast enhancement was achieved with Definity injection administered per protocol without adverse effects. The left ventricular chamber size is normal. The distal half of the septal and anterior wall as well as the distal lateral and apical walls were akinetic, and the rest of the ventricle contracted normally. Swirling contrast consistent with sluggish blood flow was present in the left ventricular apical region. The presence of above findings may potentially affect the accuracy of the stress echocardiographic findings, and the test was not completed. A Nuclear Adenosine Stress Test has been scheduled instead."_

The Nuclear Adenosine Stress Test was done the day after this attempt.

Would it be appropriate to bill 93351-26-53 for the Exercise Stress Echo Study?

Laura L. Porter, CPC
Jamestown Area Medical Associates


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## deeva456 (Nov 2, 2009)

Hello,

I would use modifier 52, reduced services. Modifier 53 is used "due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostice procedure was started but discontinued".  

good luck.


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## laurap (Nov 3, 2009)

Thank you, deeva456.

Laura L. Porter, CPC
Jamestown Area Medical Associates


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