# Limited Stress Echo Question



## tfrick2 (Apr 2, 2012)

I received the following scenario from our cardiology department:

"We have a patient who has a murmur so a complete echo was ordered. The patient also says he has chest pain at rest, so the cardiologist wanted to do a limited stress echo to watch the EKG and also look specifically at the wall motion while being stressed, which the regular echo wasn't looking at.

The charges entered are:
93350
93306
93017

Would we use a modifier -59 for the stress portion that is looking at something different or would this just be one charge of rest/stress echo with a modifier -52 since the stress images are limited?"

Any guidance or suggestions you can give are greatly appreciated!


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## jewlz0879 (Apr 4, 2012)

If the echo, 93306, is truly for something different than bill it with a 59. If he did not meet every component of 93350, then you could bill with a 52. I imagine since this was 'limited' there was not doppler (93320) or color-flow (93325) that need to be billed. 

Did he supervise? If so, you would need to bill 93016. And if he did the interp and report 93018. 

Otherwise, that's how I would bill. Depending on the carrier, you may need to send documentation supporting different dx for different procedures and the m.n. of such.


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## Cyndi113 (Apr 4, 2012)

Please post the report.


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## tfrick2 (Apr 4, 2012)

*Reports for Echo and TTE - Thank you for your input!*

Echocardiogram Report:

DESCRIPTION OF PROCEDURE:
The patient's baseline EKG shows nonspecific ST changes in the inferior leads. Baseline echocardiography is within normal limits.

The patient exercised to 10 METs on the Bruce protocol and the test was discontinued, having reached the target heart rate. At peak exercise, the blood pressure was 178/84 with a peak heart rate of 157 beats per minute, which is 99% age predicted maximum. At peak exercise, there were more pronounced ST changes in the inferior leads. There is normal ______ of wall motion in all regional wall segments. The patient had no chest pain or arrhythmias.

CONCLUSIONS:
1. New York Heart Association classification 1 for activity limited by fatigue.
2. Negative Stress echo for ischemia or evidence of primary myocardial infarction.
3. No exercise induced arrhythmias.
4. The patient is at low cardiovascular risk.

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TTE Report - Complete Echo

FINDINGS:

Mitral Valve:
The mitral valve appears structurally normal.
Trace mitral regurgitation is present.

Aortic Valve:
The trileaflet aortic valve appears sclerotic and/or calcified, but opens well.

Tricuspid Valve:
Normal tricuspid valve structure without evidence of prolapse or stenosis.

Pulmonic Valve:
Trace pulmonic valvular insufficiency is present.
The pulmonic valve was not well visualized.

Left Atrium:
The left atrium is mildly dilated.

Left Ventricle:
The estimated left ventricular ejection fraction is 60%.
The left ventricle is normal in size.
Doppler analysis of left ventricular inflow suggests grade I diastolic dysfunction - impaired relaxation.
Assymetric septal hypertrophy seen.

Right Atrium:
Normal right atrial size.

Right Ventricle:
Normal right ventricle chamber size, wall thickness and systolic function.

Pericardial Effusion:
No pericardial effusion.

Pleural Effusion:
No evidence of pleural effusion.

Miscellaneous:
The ascending aorta appears normal in size.


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