The number of cases of coronary heart disease is rising daily. In the past, it was prevalent in the elderly, but it is becoming a common illness among the young generation as well. Approximately one in six deaths from cardiovascular diseases (CVDs) occurred in persons under 65 in 2023. Cardiologists are not only dealing with the increasing number of patients with heart disease, but they are also struggling with the medical billing of their services.
However, a thorough guide on cardiology CPT codes can provide great support to cardiologists. This blog discusses CPT code 93351, which is used to bill transthoracic echocardiography (TTE) with a stress test. By following the guidelines discussed below, cardiologists can avoid claim denials and secure full reimbursement of their services.
CPT Code 93351 – Description
CPT code 93351 is a comprehensive cardiac test that combines a transthoracic echocardiography with a stress test.
The physician performs a transthoracic echocardiography both at rest and under stress. This test evaluates the cardiac function and other cardiac diseases, such as coronary artery disease and heart valve problems. The patient is typically given medication or asked to run on a treadmill to evaluate cardiac function under stress. This code has both a professional and a technical component; it is not just for supervision and interpretation. Therefore, it includes:
- Transthoracic echocardiography (continuous)
- Stress test
- Electrocardiogram (ECG) monitoring, continuous
- Physician supervision
- Real-time image documentation (two-dimensional)
- Physician interpretation
- A written report
Appropriate Use Cases for CPT Code 93351
Here, we will examine a few real-world situations in which transthoracic echocardiography was performed and billed with the CPT code 93351.
Suspected Coronary Artery Disease
Suppose a patient is brought to a cardiologist’s office with a complaint of chest pain, pressure, or discomfort during physical activity. The heart specialist suspects that the patient’s coronary arteries are blocked. To confirm or rule out his suspicion, he decides to perform a comprehensive echocardiography procedure. First, he makes the patient lie down on his examination table and performs a non-invasive ultrasound procedure, transthoracic echocardiography, to evaluate the patient’s heart function at rest.
Next, he makes the patient run on a treadmill (simultaneously monitoring blood pressure and the heart’s electrical activity) until a targeted heart rate is achieved. The patient is immediately made to sit on the examination table again, connected to the echocardiography machine, and real-time images are analyzed to detect reduced blood flow to the heart. After interpretation, the cardiologist prepares a detailed report of the findings and bills his services with CPT code 93351 for fair reimbursement.
Shortness of Breath
Let’s consider a second scenario in which a patient experiences dyspnea when exercising, walking, or ascending stairs. To ascertain whether the symptoms are associated with heart disease, poor heart function, or valve issues, the cardiologist performs a transthoracic echocardiography at rest and after stress induction.
CPT code 93351 will be the correct billing code here because he supervised the entire procedure, interpreted the echocardiograms, and prepared a comprehensive report of the findings.
Cardiac Assessment Before Surgery
A complete transthoracic echocardiography is recommended to be performed before heart surgery. This test ensures that the patient’s heart function is normal for the surgical procedure. Because patients with a history of heart disease or risk factors such as diabetes, high blood pressure, or smoking are more at risk during the surgery.
Hence, the TTE test at rest and under stress, its supervision, interpretation, and reporting will be billed using CPT code 93351.
Modifiers to Append with CPT Code 93351
The following are the relevant modifiers for echocardiography code 93351.
Modifier 26
Use this modifier when the physician is only involved in the professional part of a transthoracic echocardiography, that is, results interpretation and reporting. Why? Modifier 26 denotes the professional component of a service.
Modifier TC
Modifier TC is appended to the CPT code 93351 when the facility is billing only for the technical component of a transthoracic echocardiography. Meaning, it is charging the payer for equipment use, supplies, and the technician’s service.
Modifier 76
Modifier 76 indicates repeat procedure or service by the same physician. So, you may apply it to 93351 if the same physician performed a complete TTE, including supervision, interpretation, and reporting, again on the same day on the same patient, due to medical necessity.
Modifier 77
Similarly, modifier 77 explains to the payer that the procedure was repeated due to medical necessity. However, this time, it was performed by a different physician.
Reimbursement Guidelines for CPT Code 93351
The following medical billing techniques should be used by providers to guarantee correct billing for CPT 93351 and reduce problems that result in claim denials:
Use CPT 93351 Accurately
Many billers face denials due to incorrect CPT code selection for their services. So, be sure you are applying the correct code based on your services. For clarity, CPT code 93351 includes both the echocardiography and stress test components in one code. Moreover, it includes technical as well as professional components.
Also, this test needs to be conducted in a non-facility setting, like a physician’s office or a private practice. If you try to bill the stress test separately with this code or perform the services in a facility setting, you will eventually receive a denial from the payer.
Document Medical Necessity
Insurance payers require the billers or healthcare providers to justify the medical necessity of their services. The biller must clearly indicate the patient’s symptoms, such as shortness of breath, chest pain, or suspected heart problems, to prove the necessity of a complete transthoracic echocardiography, represented by CPT code 93351.
If you submit your claim with incomplete paperwork or information, you will likely face a denial or reduced payments.
Verify Payer Guidelines
Check the payer’s policies and reimbursement guidelines before submitting claims for CPT code 93351. Payment rates, permissible modifiers, and bundling rules may vary between commercial payers and Medicare.
Final Thoughts
We tried to cover all the important details needed to bill CPT code 93351. We began by describing the code and providing some real-world examples to better understand the code usage. Next, we discussed a few modifiers that are frequently appended to this code. Finally, we provided you with some crucial billing tips to increase the chances of successful claim submission.
However, if there is still any confusion, we suggest acquiring expert cardiology billing services from NeuraBill instead of experimenting on your own and risking denials. Their certified professional coders and billing specialists have a proven track record of clean claim submissions and enhanced revenue collections.
