Recently my provider asked me to bill for CPT® codes 93015 and 93351 on a same day. When i went through the billing details then found that CPT® code 93015 should not be billed with 93351 on a same day. But still my provider wants some clarrification:
If a patient underwent stree echo through treadmill and was not able to walk enough to increase Heart Rate to target Heart rate, in other words, it would be read as inconclusive stree echo. Then the same patient will be brought back later to "dobutamine stress echo'. How should we bill the first stress echo(treadmill stress echo) even though it was inconlusive, he spent time, equipment and tech charges on doing the procedures.
Any help would be greatly appreciated
• Code, 93351, reports the combined service of a stress echocardiogram with a stress test. It is applicable to a single provider who provides this exam in the office (non-facility) setting. Replaces the combined reporting of both codes 93350 and 93015 when done in the office setting. Code 93351 cannot be reported with stress test codes 93015-93018.
I know that we should use 93351 (93350+93015) in office setting. But my question is if a pt underwent stress echo through treadmill and was no able to walk then he was brought back to do dobutamine stress echo. Then how should we bill the first stress echo because although it is inconclusive stress echo provider spent his time, equipment and tech charges for procedure.
dobutamine stress echo codes 93351,93320,93325,J1250
MY PROVIDER WANTS TO KNOW HOW TO BILL FIRST STRESS ECHO (WHICH WAS DONE PRIOR TO DOBUTAMINE STRESS ECHO ALTHOUGH IT IS INCONCLUSIVE)
Thanks for your response
Pharmacologic ECG stress testing is indicated only when the patient is unable to exercise adequately. Documentation in the patient's record must clearly indicate that the patient is unable to exercise, as well as the reason(s) why the patient cannot undergo exercise stress testing. What was actually done in first visit, what was completed, and what was interpreted? Did the patient actually walk the treadmill or just have an ECHO in the first visit? Bill what you did unless it hits a CCI edit with 0 indicator. The first test should have modifier -59. payers may roll first test (inconclusive) into Dobutamine stress test because same date of service. Can always appeal.
No, you cannot. Code 93315 can only be billed once/date of service. Sometimes, you must accept that the first attempt may not be separately paid. It's like starting an therapeutic cholecystectomy but unable to complete and reverts to an open procedure. Medicare considers this sequential and only pays the open procedure (CCI General Guidelines).
For example: exercise stress echo inconclusive, target not achieved, then the pt was sent home and he was rescheduled the other day for dobutamine stress echo.
In this case can we bill 93351 with modifier 53 on one day
dobutamine stress echo 93351 93320 93325 the other day