Question:

In a hospital or outpatient setting who should be billing for Definity when administered for a stress echo with contrast if the office does not own the equipment? Here are the options we’ve come up with:

  • Physician bills CPT® code 93352
  • Hospital bills HCPCS code C8930
  • Both bill Q9957 for the contrast

Answer:

If you are asking about billing for the contrast media itself (Q9957), only the facility providing the technical component may bill for the contrast material. The physician may not bill for the contrast material even if he or she provides it for a procedure performed at the hospital because it is part of the technical component. The physician may contract with the hospital to provide the contrast, and the hospital may pay him for it, however.

If you are asking about billing for the administration, code 93352, which you list in your question, is not billable under outpatient prospective payment system (OPPS) and should only be billed by the physician. The physician should also report one of the following stress echo codes, as appropriate:

93350 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;
93351 including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional

CPT® is a registered trademark of the American Medical Association.

This question was answered in an edition of our Radiology Compliance Manager. For more hot topics relating to cardiology and radiology services, please view our store, or call us at 1.800.252.1578 ext. 2.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.