Stress test CPT code

Stress Test CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Stress test CPT code(s) 93015 – 93018 bill for services when physicians perform a Cardiovascular stress tests using different techniques such as the maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring or Pharmacological stress. It may serve with or without supervision and interpretation.

Stress Test CPT Code Description

The following are the reasons why a physician performs a stress test:

It aids in identifying heart-related diseases

Congestive heart failure 

Heart valve disease

Congenital heart disease

Hypertrophic cardiomyopathy and coronary artery disease

Angina

Shortness of breath (dyspnea)

Arrhythmia

Dizziness or Lightheadedness

Physician supervised heart stress test. The test monitors the heart rhythm by electrocardiogram (ECG or EKG) during exercise (treadmill or bicycle). Drugs are administered to the patient to stimulate stress.

The physician continuously records the heart’s electrical activity acquired by an assistant supervised by a qualified health care professional. It aids in monitoring the stress on the heart.

Stress Test CPT code 93015 includes all the supervision, interpretation, and test. In contrast, Stress Test CPT code(s) 93016, 93017, and 93018 include management of the test, performing of test only, and understanding of priorly performed test, respectively. 

CPT 93015 bills for service when physicians perform Cardiovascular stress tests using different techniques such as: 

The maximal or submaximal treadmill or bicycle exercise

The physician Continuously monitors the electrocardiographs, including pharmacological stress. 

It includes supervision interpretation and report.

For a more in-depth description of CPT code 93015, follow >> this link <<.

nuclear stress test cpt code

Stress Test CPT code 93016 bills for service when physicians perform Cardiovascular stress tests by using different techniques such as the maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and or pharmacological stress; supervision only, without interpretation and report.

cpt code for stress test

Stress Test CPT code 93017 bills for service when physicians perform Cardiovascular stress tests by using different techniques such as the maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and or pharmacological stress; tracing only, without interpretation and report.

exercise stress test cpt code

Stress Test CPT code 93018 bills for service when physicians perform Cardiovascular stress tests by using different techniques such as the maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and or pharmacological; stress; supervision only, tracing only, interpretation and report only.

93018

Stress Test CPT Code Reimbursement 

A maximum of one unit can be a bill on the same service date of Stress Test CPT code(s) 93015-93018. In contrast, the three units allow documentation supporting the service’s medical necessity. 

The cost and RUVS of CPT 93015 are $80.96 and 2.33960 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $80.96 and 2.33960 when performed in the non-facility.

The cost and RUVS of CPT 93016 are $23.35 and 0.67474 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $23.35 and 0.67474 when performed in the non-facility.

The cost and RUVS of CPT 93017 are $42.00 and 1.21364 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $42.00 and 1.21364 when performed in the non-facility.

The cost and RUVS of CPT 93018 are $15.62 and 0.45122 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $15.62 and 0.45122 when performed in the non-facility.

Some physical therapists specializing in the area of cardiopulmonary care administer maximum graded exercise tests, rehabilitate acutely ill patients in the intensive care unit, design exercise programs to restore endurance and function for patients with organ transplants, and enable patients with acute and chronic heart or lung problems to resume functional activities. 

Some of the programs require a team of specialists (e.g., cardiac rehabilitation, pulmonary rehabilitation). The patient may be seen for more than an hour a day, progressing in multiple intervention programs, including exercise, bronchopulmonary hygiene, and education concerning cardiovascular fitness.

Stress Test CPT Code Modifiers 

The following modifiers are applicable to the Stress Test CPT code(s):

  • 22, 23, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS.

Modifier 76 is applicable with CPT 93015-93018 when a similar service performs by the Same Physician on the same service date.

Modifier 76 is applicable with Stress Test CPT code(s) 93015-93018 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 93015-93018 when a Distinct service performs by the physician and bundled with another procedure on the same date.  

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 93015-93018  when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Modifier 53 will be reported with CPT 93015-93018  if an unsuccessful stress test occurs due to unavoidable circumstances like allergic reactions to the substance.

Modifier 22 applies to CPT 93015-93018  when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with CPT 93015-93018  when general or local anesthesia administers by the physician and routinely does not require during the procedure.

Modifier 52 applies when the physician does not complete the lumbar puncture procedure and service terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 93015-93018 must apply the GA modifier to that service.

Stress Test CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

The following are ICD category 10 Payable Dx codes and report the specified level of dx code accordingly:

I20.0, I21.09, I21.19, I21.9, I21.3, I21.4, I24.1, I24.8, I24.9, I25.110, I25.700, I25.xxx, I34.0, I34.1, I34.2, I34.8, I34.9, I35.0, I35.1, I35.2, I35.8, I35.9, I36.x, I37.x, I42.x, I43, I44.0, I44.1, I44.30, I44.4, I44.4, I44.5, I4460, I44.69, I50.1, I50.xx, I70.0, I70.2xx, T82.xxx, T86.20, T86.21, T86.22, and T86.23.

Physical therapist appropriate to report 97110 based on the treatment outcome for muscle strengthening.

Medical records include all the relevant information, conditions, and complexities that may impact the treatment. The description might consist of, for example, the premorbid function, date of onset, and current function. 

Examples

The following are the examples when Stress Test CPT code(s) 93015-93018 bills:

Example 1

A 38-year-old male presents to ED with a chief complaint of dizziness. The patient reports vertigo began one day ago. Vertigo began while at home when he stood up. 

The patient describes the course of vertigo as abrupt, and The dizziness is currently 6/10. Vertigo worsened by standing, head movement, and movement. The vertigo is not worsened by breathing or lying supine. 

Anti-vertigo meds alleviate vertigo. Vertigo is associated with nausea, vomiting, and gait instability. Vertigo is not associated with a vision change. 

The patient is morbidly obese ha a higher risk of heart disease. The PhysicianPhysician ordered multiple diagnostic tests ECG, CMP, CBC, CT, MRI, and X-ray of the head and spine.

Diagnostic studies show that patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test.

Example 2

A 30-year-old female with no PMH is coming in for intermittent episodes of chest pain exacerbated by left-arm movement but is non-exertional. 

Given the positional nature of chest pain, I suspect a musculoskeletal cause. Differential includes, but is not limited to MSK-related pain/costochondritis/ ACS Pt is very well appearing with routine physical exam and vitals. She is not having any pain right now. 

The patient was not getting better by medication. Physicians ordered a CT chest and EKG to confirm that the heart was functioning correctly. 

Diagnostic studies show that patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test.

Example 3

Forty-six-year-old female with PMH of hypertension and a family history of heart disease heart murmur, LBBB dx 1 year ago, migraines, tested positive for COVID 1 month ago. 

Since yesterday afternoon, she has presented to ED c/o constant lip-tingling, lightheadedness, and left-sided chest discomfort. She woke morning with the same symptoms, and she also developed left upper extremity tingling and bilateral hand tingling. The patient did not get vaccinated for COVID. 

The patient Denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms. 

The patient has a family history of heart diseases—the physician plan to do labs, EKG, X-ray, CT, and MRI of the chest.

Diagnostic studies show that patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test.

Example 4

A 27-year-old male with PMH Systolic/Diastolic CHF (EF <15% 7/23/21, s/p AICD), COVID x2, s/p TAVR, CAD, CKD, PAD, hypothyroidism for shortness of breath. He has developed progressively worsening shortness of breath for four days. 

He noticed worsening SOB laying on his right side and with exertion. He takes his vitals daily and weighs himself daily.

He typically weighs 171lbs but has seen a 3.5lb increase in his weight to 174.5lbs over this past week, which prompted him to take one dose of alprazolam 30mg. He noticed a minimal improvement in his symptoms with the alprazolam. 

When he has episodes of coughing with phlegm, he notices a substernal discomfort. The discomfort is not alleviated with rest and not exacerbated with exertion. He has also noticed increasing yellow phlegm production, cough, nasal congestion, and rhinorrhea. 

The patient has respiratory problems along with heart issues. Diagnostic studies show that patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test. The Physician ordered EKG, Labs, CT, and MRI to diagnose for further treatment.

Example 5

A 39-year-old female presented office for dizziness, weakness, and tingling in the upper extremity. The patient denies any abdominal pain, diarrhea, vomiting, or headache in the system review. 

Physical exam revealed that the patient had an irregular heartbeat, shortness of breath, and fluid accumulation in the upper extremity, more likely edema. A physical exam strongly suggests ruling out heart-related diseases. The physician decides to do ECG/EKG, CTA, and MRA of the chest. 

Diagnostic studies show that patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test. EKG revealed that the patient is tachycardic. The physician has consulted with the cardiologist for further treatment of the patient.

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