It is going to come down to medical necessity. You are going to have to appeal this with both reports and supporting letter/documentation. There should be 2 separate interp and reports to clearly show these were 2 separate tests.
Since you already coded/billed with a -59 on the 93351 it won't do any good to add a -59 on the 93306. It's redundant, meaning.......
93351-26-59 with 93306-26 says: the 93351 is separate from the 93306
93351-26-59 with 93306-26-59 says: the 93351 is separate from the 93306 and the 93306 is separate from the 93351 (huh??)
Assuming he ordered these tests, he has to show 2 points:
1) that based on the findings of the 93306, the decision was made to do the 93351.
2) that the results of the 93306 were insufficient for use as part of 93351
Basically the 93306 is a rest study and the 93351 is a rest and stress study. He has to show he is not duplicating his serivce. What's his reports show and what DX were reported? For example:
93306-26
Indication for test: SOB
Results/findings: abnormal with decreased function
93351-26-29
Indication for test: abnormal echo
Results/findings: M and A valve regurg with EF 34%
93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
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