Cardiology Coding Alert

Question: Can we automatically report +93320 and +93325 in conjunction with 93312?

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Answer: No. Although many practices automatically add +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete) and +93325 (Doppler echocardiography color flow velocity mapping …) to 93312 (Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report), you should not add these codes unless the physician notes that the patient has acquired structural abnormalities (valve problems, acquired septal defects, etc.), says Ray Cathey, PA, FAAPA, MHS, MHA, CCS-P, CMSCS, CHCI, CHCC, president of Medical Management Dimensions in Stockton.

Caution: Be careful coding +93320 and +93325 because these two components require more than just a structural diagnosis, adds Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Spectral Doppler (+93320) is used to assess the speed and movement of the blood through the heart, Neighbors explains. This allows evaluation of any abnormal communications between the left and right side of the heart, any valvular regurgitation (leaking of blood through the valves) or stenosis (narrowing of the valve area), and the calculation of the cardiac output and the ejection fraction. Doppler is displayed in black and white.

On the other hand, Doppler color flow (+93325) may be added to enhance the image by assigning colors to differentiate the direction of blood flow, Neighbors adds. It’s not appropriate to assume +93325 is always being used. It must be documented.

Examples: Structural diagnosis and/or velocity calculations support +93320, and regurgitation supports +93325. If regurgitation is not mentioned, the physician must state within his documentation, “Spectral Doppler color flow was used during this procedure.” The procedure title is not sufficient, Neighbors says. It must be within the body of the report.