Q&A Bubble 93015 - 93018

[Luna]

I'm confused about coding from this bubble.

· 93015 Cardiovascular stress test using maximal or submaximal treadmill of bicycle exercise, continuous electrocadiographic 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


I can see that with 93015, the physician is present and monitoring the stress activity (or pharm) and also providing the interpretation and report.

In the 2013 AAPC textbook, it instructs, "If a physician monitors the test only, 93016 is reported. If a physician interprets the study and writes the report, 93018 is reported. If a physician performs both services, both 93016 and 93018 are reported."

In my limited understanding, that sounds like 93015. I'm missing something and don't quite understand when to code 93015 when a physician supervises, and provides interpretation and report VS. coding both 93016 and 93018 when a physician supervises, and provides interpretation and report.

I know the answer must be there…I'm just not getting it.

 

[Carolyn Heath]

I checked the AAPC Coder using the 93015 code and here is what I found and I used the Lay Terms section. If the physician uses all three components (supervision, interpretation, and report), you will use the 93015. If the physician does not perform all three components, you will report the specific component code which is 93016, 93017, or 93018 that represents the physician's role rather using modifier 26 or TC. I hope this helps. If not, maybe Laureen, Alicia, or Ruth can explain it better.

 

[Luna]

Thank you Carolyn. I didn't even think to check out the lay terms on the AAPC Coder Tool.

I understand that the code bubble breaks up the components so the modifier 26 is not necessary. But, I'm just confused why the instruction is to code 93016 with 93018 if the physician performs all the components instead of 93015 which already has everything together.

I tried "subject site:yadayada" sleuthing and didn't find anything helpful.

Does the difference have to do with the type of facility, or who owns the equipment? I wish I could find a solid explanation.

 

[Carolyn Heath]

I have copy and paste the last 2 paragraphs from the Lay Terms in AAPC Coder: "If the physician does not own the equipment and/or sends the patient to a hospital for the test, the code must be unbundled in one of the following ways: use 93016 if the physician was physically present at the time of the test to provide supervision use 93018 if the physician performed the interpretation and report use 93016 and 93018 if the physician performed BOTH the supervision and the interpretation and report 93017 is for the hospital or other owner of the test equipment to use to get their share of reimbursement. Modifier 26 (Professional component) is partly to blame for any confusion with these codes. Whereas it is correct to use 26 to separate out the professional component of a global code, using modifier 26 on 93015 would be inappropriate because there are codes that are specific to the professional component (93016 and 93018)." This can be found under Tips in the Lay Terms section.

 

[Luna]

After I posted last night, I went and checked the "Lay Terms" that you mentioned earlier. There it was!!! Thank you so much for pointing me in that direction. I figured it had something to do with either the type of facility or who owned what, but I was hoping to find it in print somewhere as that makes me more confident about the notes I put in my book.

Also want to thank you for your last comment. That could help others who don't have access to the AAPC Coder Tool. It's a good highlight of how the Lay Term feature can help. It doesn't just include info on the specifics of the procedure or medical terms, but also includes coding tips.

Thank you.

 

[Carolyn Heath]

You are so welcome. I just love using the AAPC Coder and I am going to get it after the trial date.

 

[Alicia Scott]

This would SO make a great slide for the Monthly webinar ladies. Cuddos to you. If you like we can have Sylvia create it for us.

 

[Carolyn Heath]

This would SO make a great slide for the Monthly webinar ladies. Cuddos to you. If you like we can have Sylvia create it for us.

Absolutely yes! Have Sylvia create a slide on the AAPC Coder for us for the monthly Webinar as I don't think a lot of people knows about it.

 

[CCO-support]

Look for this on the October slide.

 

[Alicia Scott]

See, Sylvia is so on top of things!!!!! We will make sure to give both you credit for the information you have added here. In fact we might be able to come to the forum and show the comments. Laureen navigates on the webinar.

Keep up the good work ladies. This helps everyone.

 

[Carolyn Heath]

You are so welcome.

 

[Rosetta D]

so very informative---thanks ladies!!

 

[Rosetta D]

so very informative---thanks ladies!!

so just to clarify---- if physician "owns" equipment and does all components ie supervision--interp & report then it is 90315 ( never use mod 26----and if the physician does not OWN equipment it must be coded "unbundled using codes 93016-93018 or any combo of those codes as appropriate and can use mod 26? ---

 

[Luna]

so just to clarify---- if physician "owns" equipment and does all components ie supervision--interp & report then it is 90315 ( never use mod 26----and if the physician does not OWN equipment it must be coded "unbundled using codes 93016-93018 or any combo of those codes as appropriate and can use mod 26? ---

You are correct that if the physician "owns" the equipment and provided all components the code would be 93015, and no modifier 26. The rest of that bubble breaks the components up so that modifier 26 is not needed if only one component is provided, or the services are provided by a physician not "owning" the equipment. So, if a physician owns the equipment but only provides the PC component, you would code 93017 and no modifier needed. If a physician does not own the equipment but provides all components, you would combine 93016 and 93018 instead of using 93015. Again, no modifier 26 needed.

I imagine 93015 includes a higher payment to the physician because he own the equipment and assumes maintenance on it. The rest of the codes are reduced, as only a partial service is provided. Also, the payment to a physician who does not "own" the equipment but provides all components is less because he does not assume maintenance on the equipment. But modifier 26 is not needed to reduce the payment because the components are already broken up when using 93016 with 93018 instead of 93015. So, you could say that the codes in this bubble are modifier 26 exempt.

 

[Carolyn Heath]

Look for this on the October slide.

What happened to the AAPC Coder slide that was supposed to be on the webinar? I attended and did not see it being featured on the October webinar. Just wondering. Thanks!

 

[Ruth Sheets]

What happened to the AAPC Coder slide that was supposed to be on the webinar? I attended and did not see it being featured on the October webinar. Just wondering. Thanks!

No slide on the AAPC in October, but the original post was answered on the webinar by Laureen. I think that is what Sylvia meant would happen.

If anyone reading this needs further information... the CCO Club will have the transcript and answer sheet available in the October 2013 section. Carolyn's answer in previous posts, covers it well, however! Eventually there most likely will be a video clip out on CCO's channel: http://www.youtube.com/user/MedicalCodingCert/videos

 

[Carolyn Heath]

Thanks, Ruth!