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Billing & Coding Article: Cardiovascular Stress Testing Print

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Contractor Information

Contractor Name:

Highmark Medicare Services, Inc.

Contractor Number:

12102, 12202, 12302, 12501, 12301, 12201, 12401

Contractor Type:

MAC Part A & B

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Article Information

Article ID Number

A47786

Article Type

Article

Key Article

Article Title

Cardiovascular Stress Testing

Primary Geographic Jurisdiction

Pennsylvania, Maryland, District of Columbia, NEW JERSEY, DELAWARE

Original Article Effective Date

07/11/2008

Article Revision Effective Date

09/01/2008

Article Ending Effective Date

N/A

Article Text

Coding Guidelines

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

A 12 lead EKG and/or rhythm strip performed in conjunction with the stress test is not separately reimbursed.

When reporting CPT code 93350 and C8928, the appropriate code from 93015-93018 series should also be reported to capture the exercise stress portion of the study.

When codes 93015, 93017, or 93350 or C8928 are used for a pharmacologic stress test, there is no separate allowance for intravenous access or infusion of pharmacologic agent. The pharmacologic agents may be billed separately.

Codes 93320 and 93325 may be used in conjunction with code 93350 or C8928.

Utilize HCPCS code A9700 for injectable contrast material used in echocardiography.

Bill Type Codes

11x	Hospital-inpatient (including Part A)
12x	Hospital-inpatient or home health visits (Part B only)
13x	Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00)
85x	Special facility or ASC surgery-rural primary care hospital (eff 10/94)

Revenue Codes

0480	Cardiology-general classification
0482	Cardiology-stress test
0483	Cardiology-Echocardiology
0636	Drugs requiring specific identification-detailed coding (eff 3/92)

Coverage Topic

Diagnostic Tests and X-Rays

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Coding Information

CPT/HCPCS Codes

Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. Hospitals should use guidelines and descriptors associated with the applicable Level I CPT code(s) to bill for echocardiograms without contrast.

93015	CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; WITH PHYSICIAN SUPERVISION, WITH INTERPRETATION AND REPORT
93016	CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; PHYSICIAN SUPERVISION ONLY, WITHOUT INTERPRETATION AND REPORT
93017	CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT
93018	CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; INTERPRETATION AND REPORT ONLY
93320	DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); COMPLETE
93325	DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHY)
93350	ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT
A9700	SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
J0152	INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS; INSTEAD USE A9270)
J1245	INJECTION, DIPYRIDAMOLE, PER 10 MG
J1250	INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG

Hospitals billing under OPPS are instructed to bill for echocardiograms with contrast or without contrast, followed by contrast studies using the applicable HCPCS code(s) below. They should also report the appropriate units of HCPCS codes for the contrast agents used in the performance of the echocardiograms.

C8928

TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT

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Other Information

Other Comments

Refer to LCD L27478 for more information on Cardiovascular Stress Testing.

Refer to LCD L27536 for information on Transthoracic Echocardiography (TTE).

Refer to LCD L27490 for information on Electrocardiography.

Refer to LCD L27535 for information on Transesophageal Echocardiography (TEE).

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Revision History

Revision History Explanation

Date	Article #	Description
08/29/2008	A47786	Article effective 09/01/2008 for New Jersey Part A. Effective 09/01/2008, New Jersey Part A will be added to the other jurisdictions already effective: DC Part A and DCMA Part B; Maryland Part A and Maryland Part B; Pennsylvania Part A; and Delaware Part B.
08/01/2008	A47786	Article effective 08/01/2008 for DC Part A, Maryland Part A, and Pennsylvania Part A. Article is now effective for DC Part A and DCMA Part B; Maryland Part A and Maryland Part B; Pennsylvania Part A; and Delaware Part B.
07/11/2008	A47786	Article release date.