Five Tips to Improve Coding for Cardiovascular Stress Testing
About eight million nuclear stress tests are performed each year in the United States. The number of ways to evaluate coronary artery disease (CAD) has grown a lot recently. With so many options, cardiology coding can be confusing. Here, we try to make it easier for you.
What is Cardiovascular Stress Test?
Stress tests are important tools for diagnosing heart conditions. They show how much stress a person's heart can handle. This helps doctors understand how well the heart is working.
How it is performed?
Stress is artificially put on the patient's heart to get it pumping. Usually, this is done with an exercise bike or treadmill. For patients who can't use these, a drug can be used to stress the heart.
Who performs it?
Common types of stress tests, like exercise and nuclear stress tests, are safely done in a cardiologist's office. A trained healthcare worker supervises the test, and the doctor records the heart's electrical activity.
What are effective strategies for CAD Stress Tests?
Here are some tips for coders to improve coding for cardiac stress tests.
Basic Codes for Cardiac Stress Testing
- CPT code 93015 is the 'global' code that includes all parts of the test.
- CPT codes 93016, 93017, and 93018 are used for different parts of the test. For example, 93018 is used if the doctor only reviewed the reports.
Tip 1: Review the Component Codes
When reviewing medical notes, always check which part of the test needs to be billed. Stress test codes don't need a modifier to show if they are for the technical or professional part of the procedure. They have different codes for each part. For example, if the cardiologist only reviewed the reports, use 93018.
Tip 2: Understand Facility and Non-Facility Billing
The global code for stress tests can be billed in both facility and non-facility settings. Sometimes, you need to split the codes into their parts before billing, especially in facilities. In non-facility settings, it depends on whether the practice owns the equipment. Billing the global code with POS 11 is okay if the test is done there.
Tip 3: Know What Other Procedures Were Performed
CVS stress testing can also be billed as TTE ECHO or Nuclear SPECT imaging. If TTE ECHO is done, use different codes. The global code 93351 is used for TTE ECHO in non-facility settings. If you need to bill the contrast separately, use 93350 and add-on code +93352. These are usually used in facility settings.
PROCEDURAL CODING PROFILE
*National Payment amounts have been used in this table, not specific to any MAC or Locality.
Tip 4: Distinguish Between Billing Stress Tests and TTE ECHO
You can bill CVS stress test codes 93016 and 93018 with 93350 when performed. Add appropriate modifiers as needed. However, you cannot report 93350 with the 93015 global stress test code. Also, 93351 (TTE global code) cannot be billed with 93350 or other cardiovascular stress codes (93015-93018) as per CPT coding guidelines.
Tip 5: Don't Forget to Bill Add-On Codes
For Doppler and color flow studies, you can bill them separately in addition to the parent stress test codes. Make sure the medical documentation is clear. After reviewing the medical charts, bill them with the correct component modifiers to show which part of the service was performed.
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