Cardiology Coding Alert

Question: The cardiologist performed an electrocardiogram (EKG), and then he decided the patient needed a stress echo the same day. What CPT® codes should we report for this situation? The cardiologist is in an office setting and he provided all of the components of both tests.

Colorado Subscriber

Answer: You would report the stress echo using 93351 (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; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional). Then, you would report the EKG with 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).

Modifier alert:  You’ll need to add a modifier to override the edit bundling 93000 into 93351. You may use modifier 59 (Distinct procedural service), XE (Separate encounter) or XU (Unusual non-overlapping service), depending upon your payer’s preference.

Make sure you only append with modifier XE if it’s truly a separate encounter like if the patient must leave the office and returns later the same day. Report XU if the procedure is scheduled with a sub-specialist who does not have an individual UPIN number to perform this portion of the service. However, if a different physician within the same practice reads the stress echo portion of the exam, then that physician would report the service with modifier XP (Separate practitioner) as long as the physician takes full responsibility of the sub-specialist who performed the stress echo.