Cardiology Coding Alert

Question: If the provider cant visualize some structures, can I still report a complete transthoracic echo code?

Michigan Subscriber

Answer: If the provider tries to identify and measure all required structures but cant, she should document why she could not visualize those specific elements, according to CPTs Echocardiography section guidelines. With that documentation, you may report a complete transthoracic echo (93307, Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography).

The structures required for 93307 include the following:

" Left and right atria

" Left and right ventricles

" Aortic, mitral, and tricuspid valves

" Pericardium

" Adjacent portions of aorta.

CPT guidelines state that you should include additional structures visualized, such as the pulmonary veins and artery, pulmonic valve, and inferior vena cava, as part of the service.

93306 reminder: For a complete transthoracic echo with spectral and color flow Doppler -- which you may see more often than complete echo alone -- you should 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).

Limited: You should report 93308 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, follow-up or limited study) for an exam that doesnt evaluate -- or document the attempt to evaluate -- all the structures in the bulleted list above.

AMAs CPT Assistant (September 2005) explains that the cardiologist may choose a 93308 service as a followupto a complete exam when the patient only needs evaluation of a more focused area. Or you may see a limited exam chosen in certain emergent situations.

Documentation: Remember that you need a report that includes interpretation of all obtained information, documentation of all clinically relevant findings including quantitative measurements obtained, plus a  description of any recognized abnormalities. Pertinent images, videotape, and/or digital data are archived for permanent storage and are available for subsequent review. If you dont meet these requirements, you cant report the echo separately.