Cardiology Coding Alert

Full-study echos with Dopplers pay $291 If your practice is offering AV optimization - a new approach to pacemaker reprogramming - you'll need to learn which device codes to report and whether the procedure includes a full or limited echo study, coding experts say.
 
AV optimization (also known as "echo optimization") results in device settings that generate the most beneficial pause between the atrial contraction and the ventricular contraction (the "AV delay"), says Jim Collins, CHCC, CPC, cardiology coding consultant with Compliant MD Inc.
 
Collins explains that optimizing this pause is beneficial because it "allows the ventricles to fill with blood as much as possible before they contract and push blood out of the heart." The benefits are "multi-faceted" but most notably include "increased cardiac output (the amount of blood circulated by the heart) and increased myocardial perfusion (the amount of blood supplied to the heart muscle through the coronary arteries), he says. Device Determines Reprogramming Code To bill for the optimization, you'll need to know the device type (pacemaker or defibrillator) and also any carrier/payer policies specific to biventricular device programming, Collins says.
 
For most states, you would report CPT Codes 93732 (Electronic analysis of dual-chamber pacemaker system [includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; with reprogramming) for pacemakers. For defibrillators, report 93744 (Electronic analysis of pacing cardioverter-defibrillator [includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; dual chamber, with reprogramming).
 
But at least one Medicare carrier (TrailBlazer) specifies that you should report reprogramming of biventricular devices with unlisted-procedure code CPT 93799 (Unlisted cardiovascular service or procedure), Collins says. Check for Full or Limited Echo 
 
Typically, AV optimization includes either a full or limited echocardiography study with Doppler:
 
Full study: 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete) and +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display).
 
Limited study: 93308 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; follow-up or limited study) and +93321 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; follow-up or limited study).
 
Coders cite general success in billing both study types. "We have been billing both studies and have not had problems getting them paid," says Sarah Cruz, CPC, coding specialist with Metro Heart Group of St. Louis Inc. "We bill 93308, 93321 and 93744 and have had no problems with reimbursement or denials," says Shelley Davis of Rocky Mountain Heart [...]