Internal Medicine Coding Alert

Question: Our internist went to the hospital to meet an established patient with new complaints of palpitations and tightness in his chest. The internist conducts a cardiovascular stress test using a treadmill. The internist supervises the test and performs interpretation and report, but the hospital owns the equipment. Do we need to use modifier 26 on the stress test code?

Louisiana Subscriber

Answer: In this case, you do not need modifier 26 (Professional component). Instead, you should only report the component code(s) that embodies only the work your internist performed.

The global procedure code for these stress tests is 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); this code represents the entire procedure --the supervision, tracing, interpretation and report.

Rather than reporting 93015 and attaching modifier 26 to indicate you are only coding for the professional component, CPT has broken the code into three separate components. The coder should only report the code(s) that represent her physician's actions:

• 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,) for the physician's participation in supervising the stress test. (Use this code when the facility owns the equipment.)

• 93018 (... interpretation and report only) for the physician's interpretation and report.

• 785.1 (Symptoms involving cardiovascular system; palpitations) linked to 93016 and 93018 to represent the patient's palpitations.

• 786.59 (Chest pain; other) linked to 93016 and 93018 to represent the patient's chest discomfort.