Cardiology Coding Alert

Be sure you know which setting this new code applies in.

CPT 2009 shakes up your stress echo coding, but you can prepare your front lines now using these expert insights.

CPT 2009 expands and changes your stress echo coding choices. Here are the 2009 codes (one revised, two new) and the notes with them:

• Revised: 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 (The appropriate stress testing code[s] from the 93016-93018 series should be reported in addition to 93350 to capture the exercise stress portion of the study).

• New: 93351 -- ... including performance of continuous electrocardiographic monitoring, with physician supervision (Do not report 93351 in conjunction with 93015-93018, 93350)

• New: +93352 -- Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)(Do not report 93352 more than once per stress echocardiogram; use 93352 in conjunction with 93350, 93351).

Remember that you report a complete stress test with 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report).

But there are actually three distinct portions of a full cardiovascular stress test, and the individual components have their own codes. The appropriate component codes are as follows:

• 93016 -- ... physician supervision only, without interpretation and report.

• 93017 -- ... tracing only, without interpretation and report.

• 93018 -- ... interpretation and report only.

If your doctor performs all three portions of the study, you would report the package code (93015). You would report the appropriate sub-component codes (93016-93018) if the doctor performed only one or two of the subcomponents, but not all three, explains Jim Collins, CCC, president of CardiologyCoder.Com.

2008: For 2008 services, you report the appropriate stress test code(s) (93015-93018, depending on whether you are reporting the complete study, one subcomponent, or two subcomponents) in addition to stress echo code 93350, Collins says. In CPT 2008, instructions with 93350 say to report it in addition to 93015-93018, he says.

2009: The note with 93350 in CPT 2009 states you should report 93350 only with 93016-93018, Collins says. In other words, CPT 2009 specifically excludes complete stress-test code 93015 from use with 93350, he says.

What to do: "Guidance in CPT establishes that if the doctor does the work that is described by code 93015 (the full stress test) in addition to the stress echo, he should report 93351 for the full study (including the stress echo and all three components to the stress test)," says Collins.

Bottom line: The new codes will change how you report office-based stress echos, Collins says:

• 2008: 93350, 93015

• 2009: 93351.

If you provide a service less than a complete study, such as a hospital-based stress echo, your coding will remain the same, says Tammy Judd, CPC, CPC-CARDIO, with Heart Clinics Northwest in Spokane, Wash.

For 2008 and 2009 hospital-based services you should report 93350, 93016, and 93018.

CPT 2009 also adds +93352. Reason: CPT guidelines explain that the patient may receive echo contrast intravenously both at rest and with stress if the standard echo doesn't adequately identify left ventricular endocardial borders.

You use +93352 to report the contrast administration -- but note that you can still report the supply of the contrast separately (for example, A9700, Supply of injectable contrast material for use in echocardiography, per study), just as you can report drugs used to induce stress separately (for example, J0152, Injection, adenosine for diagnostic use, 30 mg [not to be used to report any adenosine phosphate compounds; instead use A9270]), Collins says.

And remember that because +93552 is an add-on code, you must report it with an appropriate primary code. CPT designates 93350 and 93351 as the appropriate primary codes for +93352.

Remember: Code +93352 is for contrast administration during a stress echo only.