Practice Management Alert

Question: Would you explain when it is appropriate to use 93015 and when it would be better to bill 93016 and 93018?

Texas Subscriber Answer: Billing global code 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) is the right choice "when all components of the code are performed by a single entity," including use of test equipment and physician supervision, interpretation and report, says Kathy Pride, CPC, CCS-P, with QuadraMed in San Rafael, Calif. But, she says, the physician must own the  stress-test equipment and the test must be performed on this equipment.
 
If the physician does not own the equipment and/or sends the patient to a hospital for the test, the code must be unbundled in one of the following ways:
   use 93016 if the physician was physically present at the time of the test to provide supervision
   use 93018 if the physician performed the interpretation and report
   use 93016 and 93018 if the physician performed BOTH the supervision and the interpretation and report
   93017 is for the hospital or other owner of the test equipment to use to get their share of reimbursement.
 
Modifier -26 (Professional component) is partly to blame for any confusion with these codes. Whereas it is correct to use -26 to separate out the professional component of a global code, "using modifier -26 on 93015 would be inappropriate because there are codes that are specific to the professional component (93016 and 93018)," Pride says.