Cardiology Coding Alert

You Be the Coder:

Echo With Contrast

Question: How should I report echocardiography with contrast? Also, what codes should I bill with 93307?
Pennsylvania Subscriber

Answer: To accurately report echocardiograms with contrast, you will need to determine whether the patient has Medicare coverage, the place of service, and the services the physician provided.
Patient coverage: For non-Medicare patients, you can report the imaging agent administration in addition to the echo codes and the HCPCS code for the agent, according to the American College of Cardiology Guide to CPT 2003. Medicare, however, does not allow separate payment for the imaging agent injections, so you would not report 90783 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intra-arterial) to Medicare for arterial injections and 90784 (... intravenous) for the more common venous injection.
Place of service: If the physician provides the service in the office rather than in a facility setting, you can also bill for the supply of the imaging agent. For Medicare patients (and most non-Medicare patients), report A9700 (Supply of injectable contrast material for use in echocardiography, per study). Keep in mind that the current HCPCS Level II guide lists A9700 as having "special coverage instructions." (To read these instructions, see section 15360[a] of the Medicare Carriers Manual.) The MCM specifies that, effective Oct. 1, 2000, "physicians may bill separately for contrast agents used in echocardiography. Physicians should use HCPCS code A9700." The MCM further indicates that the type of service (TOS) code for A9700 is 9, which means that reimbursement is left to carrier discretion, so you may not get paid.
Service provided:
If the physician performs the echo in a hospital, append modifier -26 (Professional component) to the echo codes. Report 93015 for in-office stress tests or 93016 and 93018 when the physician performs the stress tests in the hospital. If the physician performs a rest/stress echo, use 93350 rather than 93307, which is for real-time echos with 2D image documentation.