Primary Care Coding Alert

Question: When billing for treadmills in the office, we use 93015. Is there a different code we should assign when these studies are done in the hospital? Can we also use an IV infusion code?

Kansas Subscriber

Answer: While it is appropriate to assign 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) for a treadmill test conducted in the office, it is probably not correct to bill this code for a cardiovascular stress test done in the hospital without a modifier.

This code includes the technical component (i.e., the tracing), which the hospital, not your practice, is providing when this service is done in the hospital. From a CPT perspective, you could code 93015-26 to indicate that you provided the professional component of this service. Alternatively, some insurers, including Medicare, prefer that you code 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) and 93018 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only) in this case to reflect your provision of the physician supervision and interpretation and report, respectively. You should check with your principal third-party payers for more information regarding how they want you to code the professional component of a cardiovascular stress test performed in the hospital.

You should also check with your principal third-party payers regarding the IV infusion codes (90780, IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour, and 90781, each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) for administration of pharmacologic stress, in conjunction with 93015. Some payers may consider this part of the stress test.