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DANA Posted Mon 29th of January, 2018 10:58:43 AM
Our cardiologists are supervising/interpreting nuclear stress tests that are performed at the hospital. We have always used the 78452-26 for interpretation of the nuclear portion and then the 93016 & 93018 for supervision and interpretation of the stress portion. We now have one doctor who is doing most of the nuclear reading(78452-26) and then other physicians are performing 93016/93018. I know that there would not be a problem to split the billing for the doctors, but my question is regarding Physician Assistants. Could the PA be utilized to supervise(93016) and then the doctor reading the nuclear bill for 78452-26 and 93018? If so, what are the guidelines? Our doctors are in Georgia.
SuperCoder Answered Tue 30th of January, 2018 02:01:58 AM


In the office setting, Medicare has a physician supervision level of 2 for 93015-93018 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress ...). That means the "Procedure must be performed under the direct supervision of a physician." Direct supervision means the physician must be present in the office suite -- although not necessarily in the same room -- and immediately available to assist and direct throughout the procedure. If documentation doesn't show the physician provided that direct supervision, but the NP performs the test, then the NP's NPI should be used for that portion. Of course, this assumes the NP can perform the service under state scope of practice rules. Regarding documentation of who supervised and performed the tests, keep in mind that auditors will want to be able to determine whether the provider who billed the service actually provided the service (or met the supervision requirement).

If the NPP performs or oversees the test and a doctor interprets the result, the NPP would bill 93016 (stress test, supervision only) and 93017 (stress test, tracing only), and the doctor would bill interpretative code 93018. In this instance, the NPP would be paid 100% of the Medicare fees schedule for performing the technical component of the diagnostic test. CMS permits NPPs to perform diagnostic tests and bill for them under their own NPIs (state law permitting).


DANA Posted Wed 31st of January, 2018 11:04:13 AM
I am questioning for tests performed at the HOSPITAL, The hospital owns the equipment and we just provide the professional service. If the Physician Assistant supervises and the doctor ordering the test meets direct supervision requirements, then is it correct that we would bill the 93016 for the supervising physician and then the doctor who interprets would bill 78452-26 and the 93018? In the hospital setting(hospital owns equipment), we would not use 93017, right? As for documentation, I am assuming that somewhere in the progress note for the patient, the "supervising physician" needs to be listed. Is it sufficient for the PA to make the statement as to who the supervising physician is, or does the doctor himself need to be the one to make the statement? Is supervising doctor required to actually sign off behind the PA for this service? Thank you so much for your help!
SuperCoder Answered Thu 01st of February, 2018 01:11:11 AM


>CPT code 93016 - this procedure must be performed under direct supervision. The physician needn’t be present in the room, but must not be performing another procedure that cannot be interrupted, and must not be so far away that he or she could not provide timely assistance.

>In the physician office, and for hospital outpatient diagnostic services provided under arrangement in nonhospital locations (such as independent diagnostic testing facilities and physicians’ offices), the supervising physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.

>For services furnished directly or under arrangement in the hospital or an on-campus provider-based department (PBD), the supervising physician must be present on the same campus and immediately available to furnish assistance and direction throughout the performance of the procedure. That is, the Centers for Medicare & Medicaid Services (CMS) permits direct supervision from locations that are not in the hospital space, but that are “close,” as long as the physician is immediately available. The supervision physician need to sign the document as prepared by the physician assistant.


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