Cardiology Coding Alert

Use the scenario details to arrive at an answer.

A reader recently wrote in with a cardiac stress test conundrum. Test your coding skills to see if you know how to report the scenario, then check out the breakdown of the correct codes with thorough explanations.

Question: I am new to cardiology, and I recently had to code a cardiac stress test. I found the correct section in the CPT^® manual, and I think I should be looking at codes 93015, 93016, 93017, and 93018. I’m just not sure which is the correct code to report. Can you please help me?

Op Report:

In his cardiology office, Dr. Jones the cardiologist administered a cardiac stress test for the patient Mr. Smith. Dr. Jones hooked up Mr. Smith to heart monitoring equipment, and Mr. Smith walked slowly on a submaximal treadmill. The treadmill’s speed increased and tilted to simulate Mr. Smith going up a small hill. During the stress test, Dr. Jones continuously monitored Mr. Smith’s heart rate, breathing, blood pressure, and level of tiredness. Dr. Jones also supervised the recording of electrical activity of Mr. Smith’s heart to examine any abnormality in its functioning. Dr. Jones obtained blood pressure and electrocardiograph readings at regular intervals while Mr. Smith’s heart was under stress induced by the exercise. Finally, Dr. Jones interpreted the collected data and completed a report on the findings.

Know Which Procedure Codes to Report for Complete Stress Test

You 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) for this scenario because, according to the medical documentation, Dr. Jones performed a complete stress test in his office.

“The key here is when performed in a physician’s office, the physician owns the equipment to perform the cardiovascular stress test, and the overhead expenses (equipment, supplies, staff, electricity, etc.) is the physician’s office’s responsibility,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. “Therefore, the complete component procedure code is reported.”

A complete stress test includes all of the following three components, according to CPT^® Assistant Vol. 20, No. 1:

• Physician supervision of the test only — 93016 (… supervision only, without interpretation and report)
• ECG tracing, the technical component only — 93017 (... tracing only, without interpretation and report)
• Physician interpretation and written report only — 93018 (… interpretation and report only)

On the other hand, if the cardiologist does not perform the complete 93015 service (i.e. facility performed stress test), he should report just the code or codes that best represent the service he did perform (93016-93018), according to CPT^® Assistant.

The reasoning is that the physician does not own the equipment, does not employee the staff, and is not responsible for the overhead expenses to perform the cardiovascular stress test; therefore, the individual professional and technical component codes are reported accordingly, according to Neighbors.

Example: So, consider a when a cardiologist performs only the supervision of a stress test, without interpretation and report. In this case, you should just report the professional component, which is 93016.

Code 93016 is a professional component you report for the physician’s supervision only, without the interpretation and report, explains Theresa Dix, CCS-P, CPMA, CCC, ICDCT-CM, coder/auditor of East Tennessee Heart Consultants in Knoxville, Tennessee. You should report 93016 only if the physician provides direct supervision of the stress test. Physicians should document they supervised in order to use this code.

Reporting stress tests in the hospital: If the cardiologist reports stress tests in a facility setting like the hospital, the facility would report the technical component (93017), and the cardiologist would report the service he performed (93016, 93018, or both), per CPT^® Assistant.

Hone General Stress Test Knowledge

Stress tests allow the cardiologist to diagnose coronary artery disease, determine a safe level of exercise for the patient, and diagnose a possible heart-related cause of symptoms such as chest pain, shortness of breath, or lightheadedness.

Also, in the cardiologist’s medical documentation, you may see a stress test referred to in numerous ways, including, but not limited to the following, according to CPT^® Assistant.

• Cardiac stress test
• Cardiovascular stress test
• Exercise stress test
• Exercise treadmill test
• Exercise tolerance test
• Stress test
• Exercise ECG test