Searching for the right code to bill a cardiovascular stress test? We might have the answer! There is no doubt that medical billing is complex. However, the process becomes more challenging for certain specialties like cardiology due to the wide range of treatments and procedures involved. The main problem? Coding, especially when dealing with specialized cardiovascular stress tests!
But did you know there is a simple way to achieve coding efficiency? You just have to understand the basics. That’s why today, we will simplify CPT code 93017. So, whether you want to improve your clean claim rates or avoid denials, you can use our guide to make your cardiac stress test billing less stressful.
93017 CPT Code – Description
Struggling with the specifics of CPT code 93017? Let’s break down this code for you! This is one of the specialized cardiology CPT codes. It simply refers to a cardiovascular stress test, stress being the keyword here. To be more precise, billing teams use CPT code 93017 to report a procedure where a provider evaluates the electrical activity of a patient’s heart (ECG) under physical stress.
In simple words, healthcare providers continuously monitor the patient’s heart functions and other vital signs when exercising on a treadmill or bicycle machine. They also conduct this test under pharmacological stress — using medication to increase the patient’s blood flow to their heart.
The explanation of this code sounds simple, right? However, there is one small detail that often causes major confusion. A complete cardiovascular test involves several people and steps. CPT code 93107 only addresses the technical component of the test.
In other words, it only refers to the part where a healthcare provider obtains the patient’s data under increased physical activity. In short, this code does not cover data interpretation or reporting.
Scenarios Where CPT Code 93017 is Applicable
Want to understand the correct application of CPT code 93017? Here are a few everyday clinical situations where you can use this code to claim rightful payments for the monitoring phase of a cardiovascular stress test.
Persistent Chest Pain Evaluation
A 55-year-old man visits an outpatient clinic due to persistent chest pain. After a thorough evaluation, the doctor suspects an underlying heart condition and orders a cardiovascular (cardiac) stress test. During the test, a trained healthcare provider asks the patient to run on a treadmill to evaluate how much stress the heart can handle.
He continuously monitors and records the patient’s heart’s electrical activity and vital signs, leaving the interpretation to the cardiologist. Later, the billing team uses CPT code 93017 to report the technical portion of the cardiac stress test, allowing the trained healthcare provider to receive proper reimbursement for his service.
Before Starting a New Exercise Program
A 36-year-old athlete with hypertension and high cholesterol plans to start a new high-intensity exercise program before her race. She visits a doctor for medical clearance. After reviewing her medical history and noting a family history of heart disease, the doctor orders a cardiac stress test.
During the test, a lab technician assesses her heart condition while she exercises on a bicycle machine. He monitors and records her heart activity under increased stress for 15 minutes and sends the data to the doctor. The billing staff uses CPT code 93017 to report the technician’s role in the cardiac stress test.
Monitoring Heart Treatment Progress
A high-risk 60-year-old heart patient is following a treatment plan to manage his condition. The cardiologist prescribes a cardiovascular stress test to evaluate the effectiveness of the current plan. During the procedure, a trained healthcare provider induces stress using a treadmill.
He monitors the patient’s heart activity and vital signs until he reaches the target heart rate — 85% of the maximum heart rate expected for his age. The provider uses CPT code 93017 to bill the technical component of the cardiovascular stress test.
Applicable Modifiers for CPT Code 93017
So, which modifiers can you use with this code? CPT code 93017 already indicates that it refers to a technical part of the cardiovascular stress test. Hence, you don’t need to use the TC modifier. However, you can apply the following modifiers with this code in certain situations.
Modifier 59
You can use this two-digit modifier with CPT code 93017 to notify insurance companies that the cardiac stress test is unrelated to other procedures performed on the same day. In simple words, modifier 59 helps clarify that the test was conducted in a different session or patient encounter, helping you receive separate payments. However, only use this code if no other descriptive modifier is available.
Modifier XE
You can use modifier XE if you have performed a cardiovascular stress test at a separate patient encounter but on the same day as other services. This modifier is similar to modifier 59, indicating services performed at separate encounters. So, which one should you use with CPT code 93017? The answer is quite simple!
The Centers for Medicare & Medicaid Services (CMS) discourage the frequent use of modifier 59. Hence, if both modifiers XE and 59 are applicable with CPT code 93017, you should always choose the former.
CPT Code 93017 – Billing & Reimbursement Guidelines
CPT code 93017 has a straightforward description and application. But if you wish to avoid unexpected denials, follow these billing and reimbursement guidelines:
Familiarize Yourself with Component-Based Codes
CPT code 93017, along with CPT codes 93018 and 93016, refer to different components of a cardiovascular stress test. These include physician supervision, technical aspects, and interpretation. Each code covers different services provided by different healthcare providers involved in this procedure.
You should be familiar with these codes so you can use the correct one. For example, you can use CPT code 93017 to bill for the technical part of the test, tracing and monitoring a patient’s heart activity.
Document the Medical Necessity
Insurance companies evaluate the medical necessity of a cardiac stress test before releasing any payment. Therefore, attach comprehensive documentation with your claim, including detailed notes on the patient’s condition and the rationale for ordering this test.
Also, keep one thing in mind. If you have conducted the test using pharmacological stress instead of exercise-based stress, make sure to justify its reason.
Maintain Referral Records
Referral letters are another important thing to include in your patient’s record. Document all referrals, whether verbal or written, to avoid claim denials. This step will help you explain why you have performed a cardiovascular stress test. So, note down the date, referring doctor’s name, and reason for referral.
Follow Payer-Specific Requirements
Your test and billing should comply with payer-specific guidelines. These include supervision requirements and submission deadlines. Therefore, review and verify your region’s Local Coverage Determinations (LCD) and other private insurance companies’ policies before filing any claim for CPT code 93017.
Avoid Common Mistakes
Since CPT code 93017 is already a component code, avoid using modifier TC or modifier 26 with this code. Don’t conduct a cardiovascular stress test without any clinical reason, and clearly define each provider’s role in your documentation.
Conclusion
To summarize, we can say that coding is not an easy task for cardiologists. But they can improve their coding efficiency by understanding the specifics of common procedures, like, for example, cardiovascular stress test in this case. CPT code 93017 is one of the popular codes under cardiography procedures. It refers to the technical part of a cardiac stress test.
Use this code correctly and thoroughly document its medical necessity to receive appropriate payments for your services. We have covered everything about CPT code 93017 so you can reduce your billing mistakes and avoid claim denials. But if you still need some help, get in touch with our representatives to simplify your coding.
Frequently Asked Questions
