Cardiology Coding Alert

Look to Payers for TDI Instructions

But don't stop with color flow. You're likely to find tissue Doppler imaging (TDI) with AV optimization, so you should know how to report this, as well. Indeed, cardiology coders say they're seeing an increase in TDI -- which is an imaging technique that assesses myocardial movement throughout the cardiac cycle -- with AV optimization.

TDI allows the physician to gather extremely detailed information on the movement of the ventricles, such as the amount of time between aortic valve closure and peak ventricular wall movement. Specifically, this additional information helps to optimize conduction delay in patients with biventricular pacemakers, resulting in improved hemodynamics, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.

Here's the catch: CPT does not list a code that specifically mentions TDI. Moreover, CMS has yet to issue coverage or billing guidance for pacemaker optimization with echocardiography, so coders will need to consult individual payers' policies, coding experts say.

Weigh Unlisted-Procedure Code Options for TDI

Depending on your payers, you may see that TDI is included in the echo or Doppler codes or separately reportable with unlisted-procedure code 93799 (Unlisted cardiovascular service or procedure).

"We are billing the additional unlisted-procedure code for the tissue Doppler," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, Minn. "We have been successful obtaining additional reimbursement with a cover letter that explains what the TDI is." 

There is significant additional equipment cost and interpretation with the tissue Doppler studies, Karl says. "We also only have a limited number of physicians who have qualified to interpret the TDI component of the study."

Other practices don't bill 93799. "Most of our doctors interpret TDI and note the study in their dictation, but we do not bill for it, since there is no recognized code," says Kathy Zinger, CMM, RMC, office manager for Parkside Cardiology in Colorado Springs, Colo. "Even though the technology is there and costly to the physicians, it is just not worth the ramifications of billing it. So, for the time being, the doctors find the information useful and just eat the costs."

Include the Proper Documentation

Tip: If you report 93799, you should fully describe the TDI procedure. Typically, this means that you'll need to submit the claim on paper with a cover letter explaining the service and justifying your fee, a copy of the medical record, and supporting documentation such as Food and Drug Administration approval letters and/or peer-reviewed literature.

If you supply all this information with your initial claim, you could shave months off the time it takes to collect for TDI with AV optimization procedures, coding experts say.