Forum - Questions & Answers

Dec 6th, 2018 - JL81

93351 in office Stress Echo billing question

CPT CODE 93351 Echo, Stress

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 supervision by a physician or other qualified health care professional.

The question is this...we are debating this in our non facility office.
99% of the time a qualified medical professional (nurse) is the in the stress room with a doctor in the office during stress echocardiograms.
Then a cardiologist will read the ekg and echo images after the test is completed, but this can be done by any doctor in our office. Our doctors like to read their own studies. Then we bill under physician who reported and interpreted the test. 93351... The question is:
Must the doctor that was present in building (supervision) during the stress echo also be forced to read and interpret the stress ekg and echo images in order for us to be compliant under 93351.

Thanks.

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Dec 20th, 2018 - ChrisW   130  1 

re: 93351 in office Stress Echo billing question

When reporting 93351 you are stating the test was done under the supervision by a physician or other qualified health care professional (the provider is present during the study). By reporting TC/ 26 modifiers or no modifier, you are indicating, who did the work and who did the interpretation, or that the physician did all of it If no modifier is present. Now consider; is the "Qualified health care professional" qualified to interpret the test? If not you should only bill the TC- Technical component under 93351, and the interpretation and report under the physician. All of this is taken into consideration as well as if the equipment is owned by the provider.

For Medicare under the Medicare Physician Fee Schedule (MPFS) Indicator, this procedure is listed under # 1 - Diagnostic Tests for Radiology Services, most payers will follow these same rules (verify with your payer)

Diagnostic Tests for Radiology Services -- Identifies codes that describe diagnostic tests. Examples are pulmonary function tests or therapeutic radiology procedures, e.g., radiation therapy. These codes have both a professional and technical component. Modifiers 26 and TC can be used with these codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense. The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only. The total RVUs for codes reported without a modifier include values for physician work, practice expense, and malpractice expense.

93351 also has an MPFS Indicator under Physician Supervisions of a 09, which means the "Concept does not apply" to this code. Therefore' you can not bill under a supervising physician. (D0n't let that confuse you with the code description stating "with supervision by a physician or other qualified health care professional).

This information can be found on the code information page on Findacode under "Additional Information", review the rules and use of the TC and 26 modifiers.

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