Cardiology Coding Alert

Question: I work for a multi-specialty group. We have a cardiac stress clinic to run all cardiac and vascular ultrasound exams. The stress portion of the exam is done by an internal medicine (IM) physician and the echo portion is read by a cardiologist. How should we code for each physicians work: 93350 for the cardiologist and 93015-93018 for the IM?

Colorado Subscriber

Answer: Assuming you are billing the global service, you should report the services as follows:

Cardiologist: For interpreting the stress echo only, the cardiologist should report 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).

IM: To report the professional component of the stress test, the IM physician should report 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardio-graphic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report).

Worth noting: If one provider performs the stress test and stress echo, he should report new code 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 physician supervision) to cover both.

FYI: The Medicare Physician Fee Schedule April update creates professional and technical components for 93351 (www.cms.hhs.gov/Transmittals/downloads/R1691CP.pdf).