Cardiology Coding Alert

Question: If the Nurse Practitioner (NP) is the one who performed the 93016 service and the physician interpreted the EKG, do you use the NP NPI for 93016? Also, should documentation state which provider supervised and/or administered the drugs in the actual report that goes in the patient's chart? Codify Member Answer: In the office setting, Medicare has a physician supervision level of 2 for 93015-93018 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress ...). That means the "Procedure must be performed under the direct supervision of a physician." Direct supervision means the physician must be present in the office suite -- although not necessarily in the same room -- and immediately available to assist and direct throughout the procedure. If documentation doesn't show the physician provided that direct supervision, but the NP performs the test, then the NP's NPI should be used for that portion. Of course, this assumes the NP can perform the service under state scope of practice rules. Regarding documentation of who supervised and performed the tests, keep in mind that auditors will want to be able to determine whether the provider who billed the service actually provided the service (or met the supervision requirement). For more information, see "Clarification: 93016 by NP Has Steep Requirements" in Cardiology Coding Alert, vol. 15, no. 5.