Cardiology Coding Alert

Question: Which codes should I use for a dobutamine stress echo with spectral and color flow Doppler? We perform the test in the office, and I want to be sure I’m capturing all possible codes.

Maryland Subscriber

Answer: For this test in the office, you should use these codes:

• 93351, Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional
  
• +93325, Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)
  
• +93320, Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete
  
• J1250, Injection, dobutamine hydrochloride, per 250 mg.
  

Code 93351 covers the stress test supervision, interpretation, and report; the injection (but not supply) of dobutamine, which causes the heart to beat faster like exercise would; and transthoracic echocardiography, specifically the real time 2D echo along with documentation, as well as M-mode if the provider uses it.

You should report the color flow and spectral Doppler separately using +93325 and +93320. Be sure the provider specifically documents their use.

You should report the supply of the dobutamine using one unit of J1250 for each 250 mg used.