Stress echo code 93351 and the meaning of physician supervision

Stress echocardiograms done in our hospital are done by a nurse and an echo technician. A complete transthoracic echocardiogram including M-mode, color, and spectral Doppler are performed in addition to the stress echocadiogram. The nurse evaluates the patient, gets consent, and performs the stress test without a physician in the room. There is no physician involvement or contact with most patients, but a resident is available on the floor where the stress echocardiograms are performed. There is also usually an attending cardiologist somewhere on the floor who does not have any contact with a specific patient unless they are called by the nurse.

There is controversy among physicians about how the professional components should be coded. Could you please clarify?

The Echo Lab Director insists that the following codes are correct: 93351, 93320, 93325, 93016, AND 93018.

My understanding is that 93351 should only be coded if there is continuous fact to face contact by the physician with the patient during the entire stress test (i.e., the ATTENDING physician must be in the room during the stress test) and that 93016 and 93018 are improper because they are already included in the 93351 code.

At a prior hospital in which I worked, the 93351 code was only used when the attending physician stayed in the stress test room at the hospital for the entire study. If the physician was not directly in the stress room for the entire study, then the codes submitted were 93350, 93320, 93325, 93016 and 93018.

Please help!