Monday 23 September 2013

Difference from coding a "93015 and 93325 or a 93351?

report 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), 93350 (Echocardiography, transthoracic, real-time with image documentation [2D], with or without M-mode recording, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report), and add-on codes +93320 (Doppler echocardiography ...) and +93325 (Doppler echocardiography color flow velocity mapping ...) if the documentation supports that the physician performed these procedures. See the CPT statement in parentheses under the description of 93350: "The appropriate stress testing code from the 93015-93018 series should be reported in addition to 93350 to capture the exercise stress portion of the study."

Code 93350 describes stress echocardiography only and does not include the cardiovascular stress portion of the procedure. Consequently, you need to report 93015 to cover services for the cardiovascular stress component.

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.

No comments:

Post a Comment