Some Medicare Carriers Now Accept Indications for Cardiovascular Stress Tests
Published on Wed Dec 01, 1999
Although some insurance carriers bundle cardiovascular stress tests in evaluation and management (E/M) codes, many cardiologists, depending on the carrier, can be reimbursed for the procedure using certain ICD-9 codes for signs or symptoms instead of approved diagnosis codes. But the physician will have to show the indications clearly in the medical record, says Terry Fletcher, BS, CPC, CCS-P, a cardiology coding consultant in
Dana Point, CA.
A new policy announced by Nationwide, the Medicare carrier in Ohio12 other states have similar policies with more working toward that goaldefines stress testing as one of the standard tools used to evaluate patients with signs and symptoms of ischemic heart disease and certain types of valvular disease. The tests may be exercise or pharmacologic and include electrocardiograms (ECGs), echocardiograms and radionuclide studies.
The new policy applies to the following CPT and HCPCS codes:
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)
93016 (cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report)
93017 (cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring and/or pharmacological stress; tracing only, without interpretation and report)
93018 (cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only)
J0280 (injection, aminophyllin, up to 250 mg)
J0460 (injection, atropine sulfate, up to 0.3 mg)
J1245 (injection, dipyridamole, per 10 mg)
J1250 (injection, dobutamine HCl, per 250 mg)
J0151 (injection, adenosine 90 mg [not to be used
to report any adenosine phosphate compounds, instead use A9270])
J3490 (unclassified drug)
The new policy by Nationwideone of several carriers to revise their stress test policybecame effective Nov. 1. Previously, Medicare carriers would reimburse stress tests only if the patients diagnosis matched one of a list of approved ICD-9 codes.
In the past, it didnt matter what the signs or symp-toms were because all Medicare would accept before you would get paid was an approved diagnosis. Now, if you just use signs or symptoms, your claim may still be denied at first, but because of the updated guidelines, they will look at the patients full documentation on appeal, Fletcher says.
Medical Necessity Is Key
According to the Nationwide policy, Medicare covers cardiovascular stress testing when medically necessary to guide management of patients with known or suspected coronary artery disease (CAD), some cardiac rhythm disorders, and certain types of valvular disease:
1. To aid in the diagnosis of patients with signs or
symptoms of myocardial ischemia;
2. To evaluate patients after myocardial revascular
ization or procedures [...]
