Follow These Steps for Contrast Echo Code Selection
Question: My provider is reading echos for a hospital and has read a few limited echocardiograms with contrast. I don’t see a code for this. What code(s) should I use to report this service? Connecticut Subscriber Answer: Let’s look at both components of this service. First, we must consider the limited echo: This is when less than the required nine structures (left and right atrium, left and right ventricle, aortic, mitral and tricuspid valves, aorta and pericardium) are viewed and findings documented. In some cases, limited echocardiograms are used to look at a specific area or as a follow-up after a surgery/procedure. The appropriate CPT® code to report is 93308 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study). When this is performed in the hospital for the professional fee component, make sure to append modifier 26 (Professional Component). Then, we can look at the contrast use within the echo. When contrast is used in this procedure, it is for myocardial perfusion, at rest or with stress, for the assessment of myocardial ischemia or viability. Examples of contrast material used includes, among others, Definity, Optison, or Lumason. To bill for the contrast use as well, the finding for the myocardial ischemia/viability must be over and beyond what is normally completed in the echo. When used for any other reason it would not typically be separately billable. This is a Category III code, +0439T (Myocardial contrast perfusion echocardiography, at rest or with stress, for assessment of myocardial ischemia or viability (List separately in addition to code for primary procedure)). For example: A limited 2D transthoracic echocardiogram was performed to identify shunting and myocardial viability. Conclusion: transthoracic echocardiography, image quality was fair. The study was technically difficult due to excess abdominal air. No shunting was identified. The echocardiogram was not well visualized; however, appears to be normal regional wall motion with Definity contrast. In this scenario, the appropriate codes would be 93308-26 and 0439T. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
