Cardiology Coding Alert

Question: What's the difference between using codes 93015-93018?


California Subscriber

Answer: How you'll use 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report) rather than 93016-93018 depends on what your physician performed.

For example, your physician administers a cardiovascular stress test in the office, providing the procedure's technical component (that is, the physician's practice owns the equipment, employs the staff, pays the rent, pays the utilities, etc.) in addition to the supervision, interpretation and report. In this case, you should report 93015. Focus on the latter portion of this definition, which specifies both physician supervision with interpretation and report.

Code 93015 is the correct choice because it encompasses all of the procedure's components (the equipment's use, as well as the supervision, interpretation and report).
 
Remember: The physician may initiate this method of "stress" by using pharmacological agents, such as dobutamine (J1250, Injection, dobutamine HCI, per 250 mg) or Persantine (J1245, Injection, dipyridamole, per 10 mg). Therefore, you should report the appropriate HCPCS code to describe the agent.

However, suppose a patient complains of chest pain (786.50) and palpitations (785.1), and then your physician uses the hospital's equipment to perform a cardiac stress test. Your doctor supervises the stress test and provides a written interpretation and report.

In this case, you should report 93016 (Cardiovascular stress test ...; physician supervision only, without interpretation and report) for the physician supervision. To code the written interpretation and report, you should also use 93018 (Cardiovascular stress test ...; interpretation and report only). Pay attention to the descriptors of these codes, which include key phrases such as "without interpretation and report" and "interpretation and report only."

Red flag: Be sure to ask your carrier whether 786.50 and 785.1 are listed among the ICD-9 codes that lend medical necessity. Also, check their documentation requirements.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.