Do Not Stress About Stress Test Coding
Hint: Code choice can be affected by who owns the equipment. Stress testing is used to see how the heart functions while physical activity is being performed. There are two options: exercise or pharmaceutical/pharmacological-induced. The traditional way is to walk on a treadmill or stationary bike while hooked up to an electrocardiogram (ECG) and blood pressure monitor. The provider is watching the heart rate, blood pressure, and the breathing of the patient. This testing is normally the first line of diagnosis or evaluation for other testing or treatment. The common reasons for stress testing include diagnosing coronary artery disease or arrhythmias, medication effectiveness, and pre-op for surgery. When a pharmacological stress test is performed, nuclear medication is administered in lieu of exercise. This is most widely done for those unable to exercise due to age or other comorbidities. Find Common Codes and Abide by Modifier Norms CPT® codes for stress tests are categorized by the service the provider performs, including supervision, tracing, interpretation, and report. You’ll need to check the documentation to see what aspects of the test your provider(s) were responsible for — and, for at least one code, whether they own the equipment that was used. Code 93015 is billed as the “global” service code when all components of the stress test are completed by the same provider/provider specialty group. This is normally reserved for POS 11 (Office), since in other settings the provider does not own the equipment. The date of service should be the same day the test was performed. Code 93016 should be billed when the provider is only performing the supervision of the stress test, they should be present within the suite during testing. The date of service assigned should be the date the test was performed. Code 93017 is billed for the technical portion of the service and would not be billed via the provider unless they own the equipment. The date of service should be the same date the test was performed. Code 93108 should be billed by the provider who reads and interprets the service. The date of service should be the same date signed by the provider. Sometimes These Situations Apply In certain situations, the components are performed by different providers from the same group practice; in cases where the providers do not own the equipment, the individual code components should be billed. So, the provider who supervises the test would bill only code 93016, and the provider who reads and interprets the test would bill code 93018. When a provider performs both the supervision and interpretation of the test, then they can bill both 93016 and 93018 together. Since these services, by definition, encompass the portion of the test being performed, there is no need to append modifiers 26 (Professional component) or TC (Technical component). This code set has a PC/TC payment indicator of two, meaning they are professional component only codes, otherwise known as “standalone” codes, as the relative value units (RVUs) are based on each component performed. When coding pharmacologically induced stress tests, you’ll look to category J codes. The most common drug codes billed when the stress is pharmacologically induced include: Important: These drug codes can only be billed when the drugs are acquired by the provider or their office, a practice that is typically observed in an office setting. . In the hospital setting, the facility purchases all the drugs used and therefore the drugs are not separately billable by the provider performing the test. Sometimes a nuclear study, otherwise known as myocardial perfusion imaging (SPECT), is performed with a stress test. This is done when additional testing is needed for a patient with risk factors for coronary artery disease or other common heart conditions. This service requires additional drug administration and a separate interpretation and report from the provider. Bottom line: When billing stress testing service codes, coders must know which portion(s) of the test are performed by the provider, whether the provider intends to bill for those portions, and whether the provider owns the equipment. Consider These Examples Example 1: Dr. Manning performed an exercise cardio stress test for a patient in his office (POS 11). Based on the medical documentation, Dr. Manning continuously monitored the patient’s heart rate, breathing, blood pressure, and level of tiredness during the procedure. Dr. Manning owns his equipment, employs the treadmill tech, documented his interpretation, and also reported the ECG data and the patient’s hemodynamics monitored during the procedure. You would assign code 93015 for this scenario because Dr. Manning performed all three components of the 93015 cardiac stress test service in his office. Example 2: Your cardiologist, Dr. Breading, performed a pharmacologically induced stress test for a patient using POS 21 (Inpatient hospital). Dr. Breading performed the direct supervision of the stress test. He also performed the interpretation and documented a written report of the test findings. For this example, the hospital would report 93017 for the technical component since they own the stress test equipment. You would assign 93016 for Dr. Breading’s direct supervision and 93018 for the interpretation of the test and written report. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
