Cardiology Coding Alert

Remember: Only report global code if physician performs complete test.

If your cardiologist performs cardiac stress tests in your practice, you must stay on top of all the details in the documentation, including whether they performed a complete test or just a component of the test. You must also know if they performed as stress echo along with the test. All of these details will guide your code choices.

Follow these steps to keep your cardiac stress test coding on track.

Step 1: Report 93015 for Complete Stress Test

When your cardiologist performs a complete cardiac stress test, you have one option to report: Code 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report).

Code 93015 includes your cardiologist’s supervision of the stress test, the supply of the equipment, tech, and electrocardiogram (ECG) tracing, and your cardiologist’s interpretation and report.

Coding tip: When it comes to the place of service (POS) for 93015, this code can only be reported by a physician in a nonfacility setting, according to CPT^® Assistant Vol. 20, No. 1. A nonfacility setting is defined as an office, clinic, or diagnostic testing center. Additionally, you should only report 93015 if just one, single physician performs all three components of the 93015 service in a nonfacility setting.

Step 2: Identify Stress Test Component Codes

If you have a case where one provider does not perform the complete cardiac stress test procedure (93015), the various providers involved should report the following component codes. Which code you report for each provider is dependent upon which part of the stress test procedure they perform:

• 93016 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report). This code presents the professional component of the cardiac stress test. Report code 93016 if your physician just performs the supervision for the test.
• 93017 (… tracing only, without interpretation and report). This code presents the technical component of the cardiac stress test. Report code 93017 for the ECG tracing only. This component includes technicians, providing the cardiac stress test equipment, paying for the rental space, utilities, and supplies.
• 93018 (... interpretation and report only). This code presents the professional component of the stress test. Report code 93018 if your physician performs the interpretation and written report only for the test.

Coding tip: When your cardiologist performs a cardiac stress test in a facility setting, for example, a hospital, the hospital will report the technical component of the stress test, and the physician will report the applicable component codes — either 93016, 93018, or both codes, according to CPT^® Assistant. Make sure that your physician just reports the component of the stress test that they actually performed.

Step 3: Puzzle Out How to Report Stress Echoes With Stress Tests

You may encounter some situations where your provider performs a stress echo with a stress test. In this case, you may turn to the following codes:

Code 93350: 93350 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;) Note: Report code 93350 when your cardiologist performs and interprets a stress echocardiogram without all of the components of stress testing (93015).

To identify the exercise stress test part, report the appropriate cardio stress component code from 93016-93018 in conjunction with 93350.

You can report 93350 in either nonfacility or in a facility setting, per CPT^® Assistant.

If different physicians perform the stress test and echocardiogram in a nonfacility setting, then one physician should report 93350 and the other physician should report the appropriate stress test codes from 93016-93018, according to CPT^® Assistant.

If your physician performs the stress test and echocardiogram in a facility setting, then report 93350 to report the performance and interpretation of the stress echocardiogram. Then the same or different physician should report the appropriate stress test code from 93016-93018 based on the service they performed.

Code 93351: 93351 (…including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional) Note: Report 93351 when your cardiologist performs a complete stress echocardiogram, along with a complete cardio stress in a nonfacility setting, according to CPT^® Assistant.

“If your physician performs Doppler and color flow, you can separately report these services with the stress echo,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “Doppler uses sound waves to measure the speed and direction of blood flow through the heart. Color flow measures blood flow velocity and is useful for imaging blood flow through the heart, assessing valves for regurgitation and stenosis, and detecting intracardiac shunts.”

Report +93320 (Doppler echocardiography, pulsed wave and/ or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete) or +93321 (Doppler echocardiography, pulsed wave and/ or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in addition to codes for echocardiographic imaging)) and +93325 (Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)), Peterson adds.