Cardiology Coding Alert

Interpretation only, or supervision, too? The answer affects your coding.

If coding for cardiac stress tests makes you want to pull your hair out, you are not alone. Understanding the nuances of the appropriate stress test codes can be tricky. Here's how to avoid the confusion so you can seamlessly report stress tests.

Notice What Happens During Stress Tests

Cardiologists use stress tests, also known as treadmill or exercise tests, to see how well a patient's heart deals with work, according to the American Heart Association (AHA).

When a patient takes a stress test, the cardiologist (or tech) hooks up the patient to heart monitoring equipment, and the patient walks slowly on a treadmill. Next, the treadmill's speed increases and tilts to simulate the patient going up a small hill. During the test, the cardiologist monitors the patient's heart rate, breathing, blood pressure, and level of tiredness.

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.

Grasp 93015 - Several Codes in One

When it comes to reporting stress tests, the 2017 CPT^® manual gives you the following options:

• 93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharma­cological stress; with supervision, interpretation and report
• 93016, ... supervision only, without interpretation and report
• 93017, ... tracing only, without interpretation and report
• 93018, ... interpretation and report only.

Problem: The way that the CPT^® manual lists the above codes could suggest that they work together. This interpretation isn't correct, but the manual does not offer any extra explanation beyond the descriptor language for the codes' appropriate usage.

Solution: You can look to an article in the January 2010 CPT^® Assistant to see the close connection between the stress test codes.

According to CPT^® Assistant, 93015 represents a complete cardiac stress test procedure, which includes the technical and professional components of the service - 93016, 93017, and 93018. To correctly report 93015, one cardiologist must perform all three components in a nonfacility setting like an office, clinic, or diagnostic testing center.

If the cardiologist does not perform a complete 93015, he should report just the code or codes that best represent the service he did perform (93016-93018), says CPT^® Assistant.

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), according to CPT^® Assistant.

Bonus tip: The PC/TC indicators for these codes in the Medicare Physician Fee Schedule also can help you use these codes correctly:

• Code 93015 has indicator 4, meaning it's a global test code that describes selected diagnostic tests where there are associated codes that indicate (a) the professional component only and (b) the technical component only.
• Codes 93016 and 93018 have indicator 2, meaning they are professional components only. Codes 93016 and 93018 describe the physician work portion of selected diagnostic tests where there is an associated code that describes the global test.
• Code 93017 has indicator 3, meaning it is the technical component only. Code 93017 indicates the staff and equipment costs of selected diagnostic tests where there is an associated code that describes the professional component of the diagnostic test only.

Understand the Individual Component Codes of 93015

Let's dig deeper into each component of 93015 - 93016, 93017, and 93018 - to see what it means when a cardiologist reports these codes.

1. Code 93016 is a professional component you report for the physician's supervision only, without the interpretation and report. Medicare's diagnostic test supervision guidelines require this component.

Expert tip: "Report 93016 only if the physician provides direct supervision of the stress test," says Theresa Dix, CCS-P, CPMA, CCC, ICDCT-CM, coder/auditor of East Tennessee Heart Consultants in Knoxville, Tenn. "Physicians should document they supervised in order to use this code."

2. Code 93017 represents the service's technical component such as technicians, providing the equipment, paying for rental space, utilities, supplies, etc. You use 93017 for tracing only, without the interpretation and report.

Expert tip: For tests performed in a facility setting, only the facility reports 93017, according to Dix.

3. Code 93018 is a professional component.

Expert tip: Report 93018 if the provider provides an interpretation and a written report, says Dix.