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Internal Medicine Coding Alert

Reader Question:
Reduce Stress, Use This Supervision Code in This Cardio Test Scenario

Question: Our physician has been sending patients to a local hospital for stress echo testing. The hospital provides the equipment, and a local cardiologist interprets the results and sends them on to our practice. We have been billing 93350-26 and 93016 for supervision of the service, but we are now being told that we cannot do this because the hospital is billing 93350-TC for the equipment and the cardiologist is billing 93350-26 for the interpretation. Should we report 93351 for the supervision instead? Or should we report 93016 for supervision without interpre­tation and report of the EKG portion of the test?

Iowa Subscriber

Answer: As your provider is only supervising the tests, billing 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) would not be appropriate for your practice. The code includes both the provision of the test and its interpretation and report, which the hospital and cardiologist correctly bill using modifier TC (Technical component) for the equipment use in the hospital's case, and modifier 26 (Professional Component) for the interpretation and report in the cardiologist's case.

Similarly, you would not bill 93551 (... including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional) as even though supervision is a component of that service, interpretation and reporting are still included in it, and using either of the modifiers does not truly describe the service your physician is providing.

Instead, your best bet would be to report 93016 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report), which most accurately represents your provider's role in the service.