Cardiology Coding Alert

Question: My cardiologist performed an echo and discovered a patent foramen ovale (PFO) that doesn't warrant any treatment. Should I use the normal echo codes or the congenital anomaly ones?

Texas Subscriber

Answer: If your cardiologist isn't aware that a congenital anomaly exists until he performs the normal echocardiography, you can change your focus to congenital codes 93303, 93304, 93315-93317 as appropriate.
Keep in mind: This rule remains true even if your cardiologist finds a congenital abnormality with little or no clinical significance. You should still report the congenital echocardiography codes.

This means that if your cardiologist discovers the PFO, you would still use the congenital echo codes (93303, 93304, 93315-93317). Even though the PFO is likely to close, it's still a congenital heart defect and therefore a congenital echocardiogram exam.

Watch out: When a patient undergoes an echocardiogram and the results do not point to congenital heart disease, you should not report the congenital echocardiography codes. You will not have justification.
  For example, if your cardiologist suspects congenital heart disease because a physician detected a heart murmur in a newborn baby or the patient's family history suggests that a congenital anomaly might be present, he might order a congenital echocardiogram.

If the results do not reveal anything congenital, you must report the normal echo codes (93307, 93308, 93312-93314).

-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC-CARDIO, president of CardiologyCoder.Com Inc. and compliance manager for several cardiology groups around the country.