Is your practice losing revenue because you don’t know the difference between CPT codes 93015, 93016, 93017, and 93018? Let us simplify this for you! We all know how complicated medical billing is, but coding for a cardiac stress test is on another level.
You must accurately distinguish between different codes for different test components, including physician supervision, technical part, and interpretation. These codes allow you to collect appropriate reimbursements for each provider involved in the assessment.
But what if you want to bill the entire procedure? You can use CPT code 93015! Let’s take a closer look at this code so you can bill all the components of an ECG stress test appropriately.
CPT Code 93015 – Description
CPT code 93015 is a global code for a cardiovascular stress test. Simply put, it includes all components of the procedure, such as:
- Professional supervision (monitoring the patient during the test)
- Technical component (collecting data, such as heart rate, blood pressure, oxygen levels, and electrical activity during exercise)
- Professional interpretation and reporting (analyzing the recordings to identify any abnormalities)
Before we go any further, let’s quickly review what a cardiac stress test is. This assessment helps healthcare providers evaluate how well a patient’s heart functions under stress. In simple words? When the heart is working its hardest.
It is typically performed when a patient walks on a treadmill, pedals a stationary bike, or is under pharmacologic stress, all while being hooked to an electrocardiogram (ECG/EKG). Keep one thing in mind! Not all facilities or providers perform every part of the test. Often, these services are divided among different professionals.
Therefore, use CPT code 93015 only when a single provider, typically a cardiologist, performs all stress test components, that is:
- He monitors the patient in real time,
- Interprets the collected data and
- Documents the findings.
Scenarios Where CPT Code 93015 is Applicable
So, when should you use this global code for cardiovascular stress tests? Here are three specific examples of CPT code 93015 to help you understand it better.
Stress Test for a Pilot with Hypertension
Did you know that people in high-risk occupations also undergo stress tests to ensure fitness? Let’s consider pilots for our first example! Suppose a 35-year-old pilot has a history of hypertension. Since he is at a major risk of developing coronary artery disease, he is required to clear the Class 3 medical certificate — a medical clearance issued by the FAA to all private pilots.
He visits a cardiologist and undergoes a standard cardiac stress test. The doctor supervises the entire procedure, placing electrodes on the patient’s chest and recording his electrical activity while he walks on a treadmill at regular intervals. He increases the incline and speed every 3 minutes to monitor how well the patient’s heart performs under increased exertion.
The cardiologist then interprets the collected data, assesses the severity of the condition, and documents the findings. He uses CPT code 93015 to report this procedure.
Cardiac Stress Test After CABG
For our next example, let’s consider a cardiac stress test following coronary artery bypass grafting (CABG)! Assume a 56-year-old woman experiences pressing chest pain spreading to her arm, shortness of breath, and weakness. She visits her nearest cardiology clinic.
The doctor reviews her medical record and notes that she had a CABG six years ago. Since enough time has passed, the patient is eligible for a cardiac stress test to identify potential problems. The cardiologist then evaluates the patient’s physical condition and performs a stress test via treadmill.
He records the patient’s heart rate, blood pressure, and electrical activity while she walks on a treadmill with increasing intensity. The cardiologist then interprets the recordings, diagnoses angina, and documents the results. Since the complete test was performed at the doctor’s office, the billing team uses CPT code 93015 to file a claim.
Preoperative Cardiac Stress Test for a Patient with Advanced CAD
About 1 in 20 adults aged 20 or above have coronary heart disease. So, let’s envision a scenario based on this! Suppose a 46-year-old man with advanced coronary artery disease (CAD) is scheduled to undergo a major surgery, a bypass, due to a blockage in the left main heart artery.
Due to high operative risk, the doctor performs a stress test as a preoperative assessment to determine whether the patient can safely undergo surgery. He places the electrodes and fully supervises the test, monitoring the patient’s stats while he pedals on a stationary bicycle.
After recording the patient’s electrical activity, the doctor interprets the results, clears the patient for the procedure, and records the findings. The billing staff then uses CPT code 93015 to report the procedure.
Applicable Modifiers for CPT Code 93015
So, which modifiers do healthcare providers commonly use with CPT code 93015? Before listing the applicable codes, here is a simple reminder: CPT code 93015 represents a global service.
Therefore, you cannot use TC or 26 modifiers with this code to indicate technical and professional components. If the test is split among different providers or locations, report them with separate codes (93016, 93017, and 93018).
Returning to the topic, here are a few applicable modifiers for CPT code 93015.
Modifier 59
You can use modifier 59 with CPT code 93015 if you have performed the stress test alongside other procedures. However, the test must be unrelated to them. For example, you performed a blood test to monitor the effectiveness of diabetes treatment. Later in the day, you performed a cardiac stress test to evaluate the patient’s symptoms (such as shortness of breath and chest pain).
Remember that insurance companies generally prefer more specific codes than modifier 59 to identify distinct services.
Modifier XE
Modifier XE indicates the specific reason for a service to be distinct. Apply this NCCI PTP-associated modifier to CPT code 93015 if you performed the cardiac stress test at a separate encounter but on the same day as other services.
CPT Code 93015 – Billing & Reimbursement Guidelines
Want to keep your cardiovascular stress test coding on track? Follow these billing and reimbursement guidelines for CPT code 93015:
Use CPT Code 93015 to Bill a Complete Stress Test
As we have emphasized multiple times in our blog, CPT code 93015 is a global code for cardiac stress. This means it includes all the components of this assessment.
Hence, only use this code if you have performed a complete stress test by yourself, without anyone else’s involvement. Otherwise, use different codes.
Report CPT Code 93015 Only in Non-facility Settings
Place of Service (POS) is another crucial consideration! Only a physician can report CPT code 93015 when they perform a stress test in a non-facility setting. These may include an office, clinic, or diagnostic testing center. Remember, you cannot use this global code if the test is performed at a facility such as a hospital.
Want to know why? Because the hospital will be responsible for reporting the technical component (CPT code 93017), and the physician will either bill for supervision (CPT code 93016) or interpretation (CPT code 93018) of the test.
Verify the Coverage Requirements
As usual, insurance companies, especially Medicare, only cover cardiovascular stress tests if they are medically necessary. Therefore, verify your patient’s eligibility before performing and billing for CPT code 93015. Eligible patients include those who:
- Exhibit symptoms of coronary artery disease (CAD) or related conditions.
- Have a metabolic disorder that can cause CAD (e.g., diabetes mellitus or syndrome X).
- Require follow-up testing after CABG (coronary artery bypass grafting), MI (myocardial infarction), or other revascularization procedures.
- Need a preoperative heart assessment when at intermediate- or high-risk for CAD.
Medicare does not consider this test medically necessary if performed too frequently. Moreover, it does not cover a cardiac stress test for screening purposes or when performed solely for lifestyle changes.
Justify the Medical Necessity of the Stress Test
After establishing medical necessity, the most important thing is to justify it. How to do that? The answer is simple—through supportive documentation! Start by documenting the following details in the patient’s medical record:
- A clinical diagnosis
- Specific reason for performing the test (relevant symptoms and conditions)
- Test frequency (annual testing, post-CABG, or post-MI)
- Test components (performance of all test components and their results)
- Referral order
Summary
To bring it all together, coding knowledge is essential, especially for accurate cardiology billing services. CPT code 93015 is important for reporting a complete cardiovascular stress test. However, only physicians can use it if they have performed all test components in a non-facility setting, such as their office, clinic, or testing center.As usual, we have discussed this code in quite detail, simplifying its description and highlighting the applicable scenarios and modifiers so you don’t miss out on any revenue opportunity. All you have to do is verify your patient’s eligibility and justify the medical necessity with complete documentation while using CPT code 93015. Don’t forget — accurate coding can make all the difference!
