Stress tests might be intense for your patients, but their coding shouldn’t be stressful for you! Did you only interpret a cardiac stress test? Keep in mind that you cannot bill for it using a global service code. Every cardiologist and cardiology professional knows that a stress test has three components: supervision, the technical part, and interpretation, each represented by a different code.
You should understand their differences to receive proper payment for your efforts. So, which code covers the provider’s interpretation? The answer is CPT code 93018! Healthcare providers often miss or misuse this code, leading to underpayments and even claim denials. But you don’t have to worry anymore! Let us explain how you can use CPT code 93018 like a pro!
CPT Code 93018 – Description
CPT code 93018 refers to the professional part of the cardiac stress test. To be more specific, it covers professional interpretation and documentation of the test results. Let us explain this code in simple words!
Healthcare providers use CPT code 93018 when they only analyze and interpret the recordings of the patient’s electrical heart activity. In other words? They are not involved in the other components of the cardiovascular stress test, such as supervising and monitoring the patient and recording their electrocardiogram readings.
In short, this code can only be used when cardiologists:
- Identify and diagnose potential heart conditions based on the recorded data
- Complete a report on the findings.
Scenarios Where CPT Code 93018 is Applicable
If you still have some doubts about using CPT code 93018, explore the following scenarios to understand its proper application:
Medical Clearance for a Private Pilot
Let’s revisit a scenario we covered for CPT code 93015! Suppose a 35-year-old private pilot with hypertension visits a specialized facility instead of a cardiologist for medical clearance.
To get the Class 3 medical certificate, he undergoes a cardiac stress test. The hospital staff conducts the test, including setup, supervision, and monitoring, but leaves the interpretation to a physician designated by the aviation authority.
Later in the day, the physician reviews the electrocardiogram (ECG) readings and assesses the severity of the patient’s hypertension. After providing medical approval, he reports his part in the procedure using CPT code 93018.
Preoperative Cardiac Stress Testing for Total Joint Replacement Surgery
The rates of preoperative stress testing vary across the US. However, one thing is certain! People at high risk of heart attacks often require a stress test before undergoing major surgery.
Suppose a 61-year-old woman is scheduled for a total joint replacement. However, due to her history of arrhythmia, her orthopedic surgeon ordered a cardiac stress test to prevent complications during the procedure.
The patient goes to a hospital’s outpatient center, where the hospital staff, including a general physician, supervises and performs the test. They send the results to a cardiologist for interpretation. The cardiologist evaluates the patient’s ECG tracing and provides clearance for surgery. He then bills for this professional component using CPT code 93018.
Cardiac Stress Test for Evaluating a Young Adult with CHD
Did you know that despite the common misconception, children with Tetralogy of Fallot (TOF) are often encouraged to exercise? TOF (a defect in which children are born with a hole in their heart) is the most common cyanotic congenital heart defect, accounting for 5% to 7% of all congenital heart defects (CHDs).
Suppose a 15-year-old boy with this inborn defect wants to start a new exercise routine. However, before proceeding with his plan, he visits a clinic for consultation due to inherent risks. The cardiologist orders a cardiac stress test to determine whether his heart can handle the new routine.
The patient visits a hospital, where the staff performs the cardiac stress test. They monitor and record his heart activity while he walks on a treadmill. The results are then sent to the patient’s cardiologist, who evaluates the readings and recommends a few changes. Hence, he reports CPT code 93018 to file a claim for his part in the procedure.
Applicable Modifiers for CPT Code 93018
As you know, modifiers help convey information that CPT codes don’t fully cover. However, not every code is suitable for every scenario. For example, you cannot use modifier 26 with CPT code 93018, as this code already specifies the professional component of a cardiac stress test.
So, which modifiers can be used with CPT code 93018? Here are some relevant options:
Modifier 59
Did you offer additional services to the patient on the same day as interpreting their ECG readings? Append modifier 59 to CPT code 93018 if the stress test interpretation and documentation are unrelated to them.
However, use this code carefully, as it is often a subject of scrutiny by insurance companies. Our advice? Review more specific NCCI PTP-associated codes to see if a better option applies to your situation.
Modifier XE
If you interpreted the cardiac stress test at a separate encounter on the same day, use modifier XE with CPT code 93018. This modifier will help you clarify that the interpretation was distinctly separate from other procedures conducted on that day because it occurred during a different session.
CPT Code 93018 – Billing & Reimbursement Guidelines
Claim denials can set you back for weeks. Follow our billing and reimbursement guidelines for CPT code 93018 to avoid such headaches.
Use CPT Code 93018 for Billing the Professional Component Only
Each component of a cardiac stress test has a different code, applicable if performed by separate individuals. Use CPT code 93018 only to bill for the professional component — interpretation and documentation of the stress test.
Confirm the Involvement of a Separate Provider
Insurance companies will only reimburse this service if a different provider is involved. In simple terms, do not use CPT code 93018 for a global service; that is, avoid using it if you also supervised or conducted the test.
Provide Supporting Documentation
To avoid complications, support your claim with proper documentation. Be sure to include:
- Summary of findings
- Clinical impression
- Recommendations
Avoid Basic Mistakes & Duplicate Billing
As we mentioned in the modifier section, CPT code 93018 already refers to the professional component of a cardiac stress test. Therefore, avoid appending modifier 26 to this code.
Also, be cautious of another common issue – duplicate billing! Keep in mind that only one provider can file a claim for CPT code 93018 per assessment. If multiple professionals are involved in the interpretation, only the physician who documented the findings should bill for this service.
Summary
And there you have it! All the details about CPT code 93018! This code is important for billing the professional services of a cardiologist in cardiac stress testing. However, many healthcare providers often get confused and use it to bill for the complete assessment.
We have provided a detailed summary of this code, along with three specific examples, so you can understand its proper application. Follow our tips to file clean claims! But if we missed something and you need extra help, our cardiology billing services can sort out all your issues.
