Cardiology Coding Alert

Question: How should I report a resting echocar-diogram and stress echocardiogram performed on the same day, with Doppler used during both tests in our office? Some plans pay it automatically, and some plans will not pay for 93320 and 93325 billed twice on one claim. We are billing the following codes all on the same claim: 93307-59, 93320-59, 93325-59, 93350, 93320, 93325 and 93015. Is this appropriate? Indiana Subscriber Answer: You list the correct codes for exercise echocardiography with Doppler and color flow: 93350 (Echocardiography, transthoracic, real-time with image documentation [2D], with or without M-mode recording, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report) for exercise echocardio-graphy, 93320 for the Doppler, 93325 for the color flow, and 93015 for the cardiovascular stress test. You should also report the echocardiography with Doppler and color flow with 93307-59, 93320-59 and 93325-59, as you indicate.You are correct to append modifier -59 (Distinct procedural service) to all three codes to indicate that the echocardiography, color flow and Doppler services are separate and distinct and should not be bundled into the exercise echocardiography. But you may need to demonstrate medical necessity for proper reimbursement. The procedure documentation would need to support reasons why the tests were done on the same day and that the components were indeed separate and distinct procedures.