Medicare Compliance & Reimbursement

Tip: Make sure the physician documents direct supervision You may think you've got stress test coding down pat, but you could be missing important details that can boost your practice's bottom line. Review the codes: You should take into account the place of service (POS) when choosing stress test codes. According to Tammy Judd, CPC, hospital coordinator at Spokane Cardiology in Washington, CPT includes four codes for the basic stress test: • 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 -- ... physician supervision only, without interpretation and report • 93017 -- ... tracing only, without interpretation and report • 93018 -- ... interpretation and report only. How to use these codes: If the entire test happens in an office setting, use 93015. This "global" code includes both the technical and professional components of the service. You won't be using modifier 26 (Professional component) and TC (Technical component) with any of these codes. In other words, if your physician performed only the professional interpretation, you will report 93018. Note: A physician would not likely report 93017 because it describes only the technical portion of the test. If the test takes place in a hospital setting (inpatient or outpatient), the physician may bill only for the professional component of the service by reporting 93016 and/or 93018. Also, you won't be coding for any supplies the physician uses because the physician didn't purchase them -- the hospital did. Local Medicare carriers and private payers likely will cover medically necessary cardiovascular stress tests. And most carriers publish a long list of diagnoses that justify a stress test. Many carriers also accept a variety of indications -- which you would document using signs and symptom codes -- such as chest pain, respiratory distress and syncope. If you use an indication (such as 786.50, Chest pain, unspecified), your physician must note it in the medical record. "The physician needs to document a valid reason for doing a stress test," says Robin Yazell, CPC, billing manager at Cardiology PC in Syracuse, NY. The physician's documentation should also note that an appropriate patient evaluation preceded the stress test, including a history and physical (H&P) and resting ECG. For example, a patient with autonomic neuropathy may not show anginal symptoms. The only sign of coronary artery disease (CAD) may be ECG abnormalities. In this case, sign or symptom code 794.31 (Abnormal electrocardiogram [ECG] [EKG]) may be an acceptable diagnosis. Some patients may not be able to use the treadmill or bicycle for a stress test. In these cases, physicians use pharmacologic stress to simulate the effects of exercise. [...]