Cardiology Coding Alert

Question: How should I report an in-office stress test? The patient also had echocardiography while at rest and during the stress test, using contrast for the stress echo (Definity).The physician supplied the complete service.

Illinois Subscriber

Answer: You should report this service 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
• +93352, Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure).

Because this is an in-office test, your practice presumably bore the cost of the contrast material. You should report this on the same claim as the service using Q9957 (Injection, perflutren lipid microspheres, per ml). The code is reported per milliliter, so be sure to check the dosage to calculate the appropriate number of units. The usual dose is up to 2 ml, although more may be necessary in patients weighing more than about 220 pounds.

Bonus: If the physician had not provided supervision, 93351 would not be appropriate. If you were reporting only the interpretation, you instead would 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).