Cardiology Coding Alert

Question: Does the cardiologist need to document viewing the pulmonary artery and veins to code a complete 2D transthoracic echo (93307)?

Delaware Subscriber

Answer: No. But if the cardiologist does visualize the pulmonary vessels, you would include that in the echo code.

Support: CPT's "Echocardiography" guidelines require examination of -- or an attempt to examine -- the following for 93307 (Echocardiography, transthoracic, real-time with image documentation [2D], includes Mmode recording, when performed, complete, without spectral or Doppler echocardiography):

• left and right atria

• left and right ventricles

• aortic, mitral, and tricuspid valves

• pericardium

• adjacent portions of aorta.

The service involves using a transducer to bounce sound waves off of heart structures to create a visual image for interpretation. A complete study requires multiple views and the clinician should record appropriate measurements.

If the clinician attempts to identify and measure all of the bulleted items above but can't, he should document the attempt and explain why it failed.

Watch for: Many practices perform and report 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) more often than 93307. The standards apply to both of these complete echo codes.

Pulmonary: CPT guidelines instruct that during a 93307 service the clinician may visualize other structures such as the pulmonary veins, pulmonary artery, pulmonic valve, and inferior vena cava. If the clinician does document these structures, include them in 93307, CPT states. Evaluating these structures is not required by CPT, but many cardiologists will document some or all of the additional cardiac structures because they are required to by accreditation standards that are close to but not quite the same as CPT's complete echo definition.

Limited: If the clinician doesn't document evaluation or attempting to evaluate all of the bulleted items above, you should report limited study code 93308 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, follow-up or limited study).

2010 update: CPT 2010 tweaks the Echocardiograpy guidelines to bring them in line with the echo code descriptors by changing "includes 2-dimensional and selected M-mode examination" to "includes 2-dimensional and, when performed, selected M-mode examination."