# Totally confused on Stress echo coding - Help!



## jdibble (Aug 21, 2014)

I have never done cardiology procedure coding and I am totally confusing myself!  From the documentation I can gather, my cardiologist did the reading on a Stress Echo with spectral doppler and color doppler done inpatient at our hospital; another person is listed as the Sonographer.  The stress portion is documented as Lexiscan nuclear stress with note stating that the nuclear images will be reported separately (I find no report on this in the patient's chart) and she is listed as the dictating doctor.

I am leaning towards codes:

93350, 93320, 93325, 93018 and not sure about 93352 as I am not sure who injected the agent and if that is what this code represents! And also not sure which codes would need modifier 26!  

If someone could kindly clear up my confusion and tell me how to code for a physician who per documentation appears to only be reading (not supervising)a Nuclear Stress Echocardiogram with spectral doppler and color doppler performed in the hospital, I would be greatly appreciative! 

Thanks!


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## MarcusM (Aug 21, 2014)

Similar to x-rays and MRI's, the nuclear technician/Sonographer/Echo tech gets modifier TC for their work and the interpreting person (radiologist/cardiologist) gets modifier 26 for their professional component/reading/interpretation work. The nuclear images would be kept separate from the patient's chart but should be available for reviews.  You will also see this  separation for EKG's.


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## jdibble (Aug 21, 2014)

Thanks Marcus - that helps with the question about the modifier!  Can you tell me which are the correct codes to use? Are the ones that I have correct or should there be other ones I should or should not use?  

Thanks again!


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## MarcusM (Aug 21, 2014)

Ahhh, Grasshopper, your journey on this path is your journey.... (teach a person to fish and you feed them for a lifetime)...time to pull out your AMA CPT Book and any cardiology books/guides the practice should have and your MAC LCD tools. You will need to learn/create a cheat sheet/template/spreadsheet to help you bill the correct codes that match the documentation. As you are finding out, there are a lot of variables, but it is doable.  Have fun.


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## jdibble (Aug 21, 2014)

> Ahhh, Grasshopper, your journey on this path is your journey.... (teach a person to fish and you feed them for a lifetime)...time to pull out your AMA CPT Book and any cardiology books/guides the practice should have and your MAC LCD tools. You will need to learn/create a cheat sheet/template/spreadsheet to help you bill the correct codes that match the documentation. As you are finding out, there are a lot of variables, but it is doable. Have fun.



LOL...trust me I know how to fish!!  Unfortunately I am the sole coder for a hospital based multi-specialty practice and my time is split between all specialties. Cardiology procedures is not one of the specialties that I have done in the past.  I have done some research - and as usual there are many many conflicting responses out there! Also the majority of the information I found gives me nothing to verify that the documentation that I am looking at is what I believe it to be!! With no other coders here to throw my questions/ideas out to, I turn to the AAPC forum to query my peers!

This practice has never had a coder before me (I have been here 1 month now), so there are no cardiology books/guides or anything here pertaining to coding or descriptions of procedures!!  They have always just billed what ever they wanted.  My purpose here is to audit their documentation to make sure it supports what they are coding and to make sure the practice is not missing billable charges!! 

So, this is why I ask my questions to the forum - it is one of my routes of education!!


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## MarcusM (Aug 21, 2014)

It has been too many years since I did cardiology work so I don't want to mislead you...BUT, I know we have some crackerjack Cardiology coders out there that can help you get a handle on your situation without you having to re-invent the wheel in the midnight hours...


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## jdibble (Aug 21, 2014)

MarcusM said:


> It has been too many years since I did cardiology work so I don't want to mislead you...BUT, I know we have some crackerjack Cardiology coders out there that can help you get a handle on your situation without you having to re-invent the wheel in the midnight hours...



Thanks Marcus for your help!


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## carolt (Aug 28, 2014)

*Stress Echo*

I bill for cardiology and a stress echo done at the hospital is coded as 93350.26 and 93018. the 93350.26 is the pc billing for the test and the 93018 is the read.
good luck!


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## jdibble (Sep 3, 2014)

carolt said:


> I bill for cardiology and a stress echo done at the hospital is coded as 93350.26 and 93018. the 93350.26 is the pc billing for the test and the 93018 is the read.
> good luck!



Thank you Carol! This is just what I needed! I find the information in the CPT book very confusing about which code to use as far as 93350 w/ 93018 vs. 93351!  You have helped answer my question!


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## jewlz0879 (Sep 3, 2014)

What about 93016? Did your physician not supervise? 

Just something to think about - if your physician performed all components in the hospital then you bill: 93351-26, 93320-26 & 93325-26. (93351 includes 93016/93018)

If, however, all services of the stress test were not performed by the same physician then you would use: 93350-26, 93320-26, 93325-26, 93016 & 93018. 

If a nuclear was performed, then your codes might be, 78452-26, 93016 & 93018. 


HTH


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