Cardiology Coding Alert

Question: How should I code the following report for 2D and spectral Doppler echo?

• Mild dilation of the left atrium, moderate hypertrophy of the left ventricle, normal LV systolic function with no focal wall motion abnormalities, ejection fraction estimated as greater than 60 percent
• Mitral valve: Annular calcification, no notable insufficiency on color flow imaging, unremarkable inflow, no systolic anterior motion noted
• Aortic valve: Moderate thickening and calcification, peak velocity across the aortic outflow is 4.3 m/sec for a peak gradient of 73 and a mean gradient of 45 mmHg, calculated aortic valve area is 0.7 sq cm consistent with severe aortic stenosis, mild insufficiency with a pressure half time of 650 msec
• Tricuspid valve: Structurally normal, no notable insufficiency, normal pulmonary pressures
• Mass, thrombus, or effusion: None identified.

Conclusions:

1. Asymmetric septal hypertrophy with preserved left ventricular systolic function
2. Severe aortic stenosis with mild aortic insufficiency

Texas Subscriber

Answer: For this study, 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). Be sure to append modifier 26 (Professional component) if you’re reporting the physician’s portion of an echo performed in a hospital.

Fortunately, the documentation specifically mentions color flow in the valve study. Color flow imaging is a specialized Doppler study that electronically tints blood different colors, depending on the direction the blood is flowing. This form of imaging helps to evaluate the degree of valvular regurgitation (also known as valvular insufficiency), which occurs when the blood flows in the wrong direction across one of the heart’s valves.

Because a pulsed wave Doppler study may also evaluate regurgitation, the documentation should specifically refer to color flow, as well as spectral Doppler for velocity, direction, and type of blood flow, to support reporting 93306.

Diagnoses: If the date of service is before Oct. 1, 2015, consider ICD-9 codes 424.1 (Aortic valve disorders) and 425.1 (Hypertrophic cardiomyopathy).

For dates of service October 1 and later, consider I35.2 (Nonrheumatic aortic [valve] stenosis with insufficiency) and I42.2 (Other hypertrophic cardiomyopathy).