Navigate When to Code Standard Echocardiograms vs. Congenital With These Tips
Hint: Don’t make your coding selection based on age alone. Echocardiography , also known as echo or echocardiogram, is a procedure that uses high-frequency ultrasound waves to create an image of the heart’s structures and function. The procedure may be used to detect irregularities, but coders need to know when to code for a standard echocardiogram versus a congenital echocardiogram. Understand the Particulars of Standard Echocardiograms The primary focus of echocardiography is the detection of congenital heart defects, evaluation of the basis of cardiac arrhythmias (irregular heartbeats), and detection of acquired heart diseases. Echocardiography may also be used for the evaluation of heart murmurs and effectiveness of medical therapy and surgical treatments. A standard echocardiogram has a complete and limited study. The CPT® code billed is based on how many of the required elements are documented with findings and whether spectral and color Doppler is used. A complete standard echo can be coded with 93306 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography) or 93307 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography) and requires the following elements: Optional additional elements: Code 93306 is a complete echo with both spectral and color Doppler used. Code 93307 is billed when a complete echo is performed without spectral and/or color Doppler. See Coding Options for Varying Situations When fewer than the nine required elements are documented with findings, limited echo code 93308 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study) would be billed. If spectral Doppler is performed with a limited echo, use add-on code +93321 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in addition to codes for echocardiographic imaging); or, for color Doppler, use add-on code +93325 (Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)). Per CPT® Assistant April 2022, if a patient has a heart transplant and no longer has any residual heart defects, then a standard echocardiogram is also the most appropriate code set to bill. Always keep in mind individual payer policies because some differ from Medicare or CPT® guidance. Use Pediatric-Specific Codes Depending on Patient’s Age Congenital echocardiograms are also billed based on complete or limited studies with codes 93303 (Transthoracic echocardiography for congenital cardiac anomalies; complete) and 93304 (Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study). Per CPT® Assistant July 2021, the congenital codes were created to differentiate from standard echocardiograms when a provider is assessing and performing echo services for infants and children with congenital cardiac anomalies. Caveat: Congenital codes are not appropriate when a congenital condition is suspected but not found. In those cases, a standard echo code is more appropriate. Some conditions, like patent foramen ovale, which can be coded with Q21.12 (Persistent foramen ovale), or a bicuspid aortic valve, diagnosis code Q23.81 (Bicuspid aortic valve), are not considered true congenital cardiac anomalies. In these situations, a standard echocardiogram is the most appropriate code set to bill based on the documentation. For the purposes of congenital cardiac echocardiograms, a complete study defines the cardiac and visceral position. A complete segmental image analysis of the heart from multiple views and also defines the cardiac anatomy and physiology as fully as possible using imaging and Doppler modalities. A limited congenital echo is defined as a general examination of one area of interest or addresses a specific clinical question. Limited studies are not sufficient if the patient with suspected congenital heart disease has never had a complete echocardiogram before. In conclusion, as a coder, always be aware of the indication for the study as well as the findings. Also, remember to pay close attention to the diagnoses in order to bill the most appropriate CPT® code for echocardiograms. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
