Internal Medicine Coding Alert

Choose codes depending on which elements your physician performed.

Review the 2012 Echocardiography guidelines that precede 93303-+93352, and you'll find new wording that clarifies coding for a stress test with a stress echo.

Complete: When a single physician performs a stress echo and a complete cardiovascular stress test, report 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).

Professional component only: If your cardiologist provides only the professional component of the stress test and stress echo (such as in a facility), CPT® guidelines instruct you to append modifier 26 (Professional component) to 93351.

This language brings the CPT® approach more in line with Medicare policy, which states that "93351 (26) is payable when performed by a physician in a facility setting" (www.cms.gov/MLNMattersArticles/downloads/MM6617.pdf).

Limited elements: In some cases, the cardiologist may perform a stress echo without performing all of the stress test's professional services. In those situations, CPT® indicates you 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) AND

Code(s) for the stress test element provided (choose from 93016-93018, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress ...).

The Medicare Physician Fee Schedule lists both professional and technical services for 93350, so remember to append modifier 26 to 93350 when you're reporting professional services only.