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Basics of Stress test cpt code 93015, 93016, 93017 & 93018

Their is a lot of confusion regarding coding Stress test cpt code. Many coders still not able to code these procedures correctly. These procedure are very frequently coded in outpatient settings. Today we will learn about the Stress test cpt codes and when should they be used.

A cardiovascular stress test (codes 93015-93018) is a study that seeks to indirectly evaluate the adequacy of blood flow to the heart muscle by recording the electrocardiogram at rest and during staged physical exercise or drug infusion. Electrocardiographic changes noted may reflect ischemic or arrhymia changes.

A cardiovascular stress test includes continuous electrocardiographic monitoring, and physician supervision interpretation, and reporting. This study may be identified in the medical record in multiple ways (i.e. cardiac stress test, cardiovascular stress test, exercise stress test, exercise treadmill test, exercise tolerance test, stress test, exercise ECG test, pharmacologic stress test, or drug infusion stress test).

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Description of Stress test cpt code 93015, 93016, 93017 & 93018

A continuous recording of electrical activity of the heart is acquired by an assistant supervised by a qualified health care professional while the patient is exercising on a treadmill or bicycle and/or given medicines. The stress on the heart during the test is monitored. CPT code 93015 includes the test, supervision, and interpretation of the report. CPT code 93016 includes only the supervision of the test. CPT code 93017 includes performing the test only and CPT code 93018 is reported for the interpretation of a previously performed test.

The CPT coding for the stress test consists of three components:

Physician supervision of the test (CPT code 93016),
ECG Tracing, the technical component (CPT code 93017), and
Physician interpretation and report (CPT code 93018).

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

93016 supervision only, without interpretation and report
93017 tracing only, without interpretation and report
93018 interpretation and report only

To improve the sensitivity and specificity of the cardiovascular stress test, a cardiovascular stress test may be coupled with an image modality such as echocardiography or nuclear perfusion imaging. When a stress echo is performed in conjunction with the cardiovascular stress test, echocardiographic images of the wall of the left heart are recorded before, after, and sometimes during the stress test to evaluate pump function (motion and thickening) of specific walls.

A stress echocardiogram (with images acquired from multiple cardiac windows), specifically describes the acquisition of cardiac images at rest and immediately after stress testing has ended.

There are two CPT codes for stress echocardiography (93350, 93351) and choosing which code to report depends on the site at which the study is performed and by whom, as discussed below.

To enhance the stress echocardiography test, other echocardiography procedures may also be performed and reported, which could include the use of a contrast agent (code 93352), spectral Doppler (codes 93320 and 93321), and Doppler color flow (code 93325). In addition, under certain circumstances, a resting transthoracic (TTE) echocardiogram (codes 93303, 93304, 93306, 93307, and 93308) may also be performed and reported on the same date of service, as a stress echocardiogram. Therefore, the use of these codes in combination with the cardiovascular stress test and stress echocardiography procedures are discussed here as well.

Stress test with Myocardial Perfusion CPT code

As per the CPT coding guidelines in the Nuclear Medicine, Cardiovascular System subsection of the Radiology section of the CPT codebook (codes 78414-78499) indicate that when myocardial perfusion and cardiac blood pool imaging studies are performed during exercise and/or pharmacologic stress, the appropriate stress testing code from the 93015-93018 series should be reported, in addition to SPECT and planar MPI code series 78451-78454, the cardiac blood pool imaging code series 78472-78483, and the myocardial perfusion Positron Emission Tomograph (PET) MPI code series 78491-78492.

For CPT code 78451, a single study is performed at rest or stress. If the test is to be done at a stress condition, it is induced with the standard treadmill exercise test or pharmacologically with the infusion of a vasodilator. For CPT code 78452, multiple studies are done at rest and/or stress with a second injection of radionuclide given again in the redistribution and/or resting phase just prior to resting images being taken. These codes also include attenuation correction (AC), which provides a more accurate diagnostic image for diagnosing defects or infarcted areas by raising the importance of radioactivity distribution counts arising from certain areas.

For instance, counts from the anterior wall may be reduced or impeded by the presence of the breast. These codes also include qualitative or quantitative wall motion, ejection fraction (EF) by first pass or gated technique, and additional quantification, when performed.

78451: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)

CPT 78452 — Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); Multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection .

As indicated in the parenthetical notes, codes 78481 and 78483 (cardiac first pass blood pool imaging), along with code 78580 (pulmonary perfusion imaging, particulate), are not to be reported in conjunction with the MPI codes 78451-78454. This is because when wall motion, ejection fraction, and quantification of relative lung perfusion are performed as part of the myocardial perfusion study, they are considered to be part of the base study and, therefore, not reported separately.

For the same reason, it would not be appropriate to report gated equilibrium blood pool study codes, 78472 and 78473, in conjunction with codes 78451-78454, 78481, 78483, and 78494.

CPT 78472 — Cardiac blood pool imaging, gated equilibrium; planar, single study at rest
or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing

CPT 78473 — Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing.multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification