Cardiology Question for the Week of February 22, 2016

Question:

During Lexiscan® nuclear medicine tests, our cardiologists require 12 lead electrocardiograms (EKGs) at initial, two minutes, four minutes, and 10 minutes. EKG monitoring (12 lead is performed throughout the procedure). What CPT can be used, or is this bundled? 

They also sometimes perform a “walking” Lexiscan® where the patient is hooked up to a treadmill and slowly walks for two to four minutes during and following the injection. The patient is continuously monitored with tracing just like a regular treadmill but for approximately a total time of 15 minutes from initial start to recovery.

The cardiologists make interpretations of both within the nuclear medicine report. Does that suffice to bill the professional component of EKG interpretation / treadmill interpretation? Or is a separate report required if PC billing is permitted?

Answer

You would not assign a code for the EKG because it is considered to be part of the stress test.

When performed in a hospital, codes 93016 and 93018 are available to bill the professional component, which may be performed by one physician or by two physicians. If the same physician provides the supervision, interpretation and report, assign both codes. Two physicians also may be involved. If one physician is responsible for the supervision, assign 93016, and the other is responsible for the interpretation and report, assign 93018.  

93016Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report

93018Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only

The hospital can bill with the following code:

93017Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report

The stress test itself is separate from the nuclear medicine scan although Medicare now packages 93017 and the stress agent (such as Lexiscan) under the hospital outpatient prospective payment system (OPPS), which means it is not separately paid. However, hospitals should still code 93017 and the HCPCS code for the stress agent because other non-Medicare payers may still issue separate reimbursement, and Medicare uses the codes in future rate-setting.  

When performed in an office billing globally, code 93015 would be assigned for the stress test. 

93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report

The interpretation of the stress portion, whether pharmacological or by treadmill, can be part of the nuclear medicine exam interpretation. However, the interpretation of the stress test portion must be clearly separated so that an auditor can determine that the physician dictating the nuclear medicine interpretation actually supervised/interpreted the stress test and is not just reporting findings by someone else.

Answer: