Optimize Stress Test Coding:
History and Pysical; E/M Services; Modifiers -59 and -25
Published on Sun Nov 01, 1998
A stress test is one of the standard tools a cardiologist uses to evaluate patients with signs and symptoms of ischemic heart disease; however, coders shouldnt become complacent about billing for them, say billing and reimbursement specialists.
Here are several reader questions that point out the difficulty in coding and documenting this mainstay of a cardiology practice.
1. On the day a stress test is performed, must a history and physical also be billed?
Heres a good rule of thumb, advises says Susan Stradley, CPC, CCS-P, senior consultant for the Medical Group of Elliott Davis and Co., LLP, headquartered in Greenville, SC. If at the time of the stress test the physician performs a review of the patients current status for the sole purpose of verifying he or she is physically stable to undergo the procedure, that review should be considered part of the procedure itself.
The amount of work done in this type of review varies by physician, with some preferring a simple review of vital signs, while others perform a more detailed exam, she says. However, in all cases, if the review is just to confirm and document the patients current condition before performing the procedure, then the E/M should not be billed separately.
The National Correct Coding Initiative (CCI) considers the stress test procedure to inherently involve some degree of physician involvement or supervision, she explains.
2. Are there times a cardiology practice would bill for an E/M service in addition to a stress test?
Yes. For example, if the cardiologist discovers hypertension and addresses it, you would append modifier -25 to the correct E/M code and get paid for the office visit as well as the stress test.
Its used to bill for an E/M with a procedure or service where otherwise the E/M would be considered part of the procedure or service, explains Stephanie Servy-Gajic, director of coding management and education at Cardiology of Georgia in Atlanta.
Remember that modifier - 25 only goes on E/M codes, says Thomas Kent, CMM, seminar leader for McVey and Associates, Nevada, CA. A lot of people get confused and try to put it on a procedure code.
The rationale is that the E/M service is over and above, and unrelated to, the performance of the stress test, adds Servy-Gajic.
Be sure that the clinical office note can stand alone for the new diagnosis (hypertention) and that the history, exam, and medical decision making components are documented.
Vicki Williams, accounts receivable manager at Charleston Cardiology Group in Charleston, WV, adds that billing for an office visit and a stress test would also be appropriate if the physician discovered abnormalities in the stress test that required additional decision making.
Check with your carrier to see if they require modifier -25 for an [...]
