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
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Stress echocardiography not justified over standard stress ECG or study incomplete
Very Common93351 (stress echocardiography) more expensive than standard exercise ECG (93015). Denied when standard stress ECG would be adequate, when patient has baseline ECG abnormalities not documented, or when study non-diagnostic. Stress echo indicated when: baseline ECG uninterpretable (LBBB, paced rhythm, LVH with strain), equivocal stress ECG, or assessing viability post-MI.
Common Causes
- • Stress echo ordered without documenting why standard stress ECG inadequate - ECG interpretable
- • No baseline ECG abnormality documented (LBBB, paced, digoxin) - standard stress adequate
- • Patient unable to exercise, pharmacologic stress not documented - dobutamine protocol missing
Resolution Strategy
Document indication for stress echo over ECG: 'Patient with exertional dyspnea, concern for CAD. Baseline ECG shows left bundle branch block - standard exercise ECG uninterpretable for ischemia with LBBB. Stress echocardiography necessary to assess for wall motion abnormalities during stress. Patient achieved target heart rate, no wall motion abnormalities seen, normal LV systolic function.' Alternative: 'Prior stress ECG equivocal with 0.5mm ST depression, unable to determine significance. Stress echo ordered to evaluate for wall motion abnormalities and clarify ischemic vs non-ischemic changes.' Must specify: why standard stress ECG inadequate (LBBB, paced, prior equivocal), stress protocol (exercise vs dobutamine), echo quality adequate for interpretation. If ECG interpretable, stress echo not justified.
Relative Value Units (RVUs)
Calculator →
Clinical Information
When to Use
For stress echocardiography with exercise or pharmacologic stress
Common Scenarios
Documentation Requirements
- Indication for stress echocardiography
- Stress method used
- Rest and stress images
- Wall motion analysis
- Interpretation and report
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes rest and stress echocardiography
- Includes stress test
- Includes interpretation and report
- Rest echocardiography coded separately
- Stress test coded separately
Exclusions
- 93350 (stress echocardiography, different code)
- 93303 (rest echocardiography only)
- 93015 (cardiovascular stress test)
- 93306 (complete echocardiography)
Coding Notes
Clinical scenarios
- Indication for stress echocardiography
- Stress method used
- Rest and stress images
- Indication for stress echocardiography
- Stress method used
- Rest and stress images
- Indication for stress echocardiography
- Stress method used
- Rest and stress images
Who are you?
Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
Automate Coding
Let OrbDoc AI automatically suggest codes from your clinical notes.
Patient? Check your bill.
Use our free analyzer to understand charges and spot errors.
Analyze My BillAsk OrbDoc AI
Get instant answers about 93351 - pricing, bundling rules, or billing questions.
Ask a QuestionFrequently Asked Questions
CPT 93351 is the billing code for "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". For stress echocardiography with exercise or pharmacologic stress
Medicare pays approximately $222.54 for CPT 93351 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 93351 has a total RVU of 17.45, broken down as: Work RVU 4.50, Practice Expense RVU 12.50, and Malpractice RVU 0.45. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 93351 is "Stress echocardiography not justified over standard stress ECG or study incomplete". 93351 (stress echocardiography) more expensive than standard exercise ECG (93015). Denied when standard stress ECG would be adequate, when patient has baseline ECG abnormalities not documented, or when study non-diagnostic. Stress echo indicated when: baseline ECG uninterpretable (LBBB, paced rhythm, LVH with strain), equivocal stress ECG, or assessing viability post-MI. Common causes include: Stress echo ordered without documenting why standard stress ECG inadequate - ECG interpretable; No baseline ECG abnormality documented (LBBB, paced, digoxin) - standard stress adequate. Appeal success rate is approximately 70-80%.
Key documentation requirements for CPT 93351 include: Indication for stress echocardiography; Stress method used; Rest and stress images; Wall motion analysis. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 93351: Includes rest and stress echocardiography. Includes stress test Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 93351 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 93351 is 60-90 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.