Cardiology Coding Alert

Question: How should you code a claim where a 93015 service and a 93351 service were performed on the same day? The plain stress (93015) was abnormal, so the cardiologist ordered a stress echo (93351). I tried appending modifier 59 to my claim, but my payer denied it. What did I do wrong?

Nevada Subscriber

Answer: This case illustrates why it’s so important to check the CCI edits when reporting multiple codes on a claim.

Per a CCI edit, code 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report) is a Column 2 code for 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). These codes cannot be reported together on the same day under any circumstances. You are not allowed to break this edit with any modifier.

Furthermore, per the CPT^® manual instructions, you should never report 93351 in conjunction with codes 93015-93018 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only) for a cardiovascular stress test or 93350 (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). You should also never report 93351-26 in conjunction with 93016 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report), 93018, or 93350-26.