Cardiology Coding Alert

Delaware Subscriber

Answer: CPT doesn't provide a code specific to the bubble study.

If you have documentation of the cardiologist's interpretation of the echo with spectral and color flow Doppler, you should report new-for-2009 code 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). Medicare won't offer additional reimbursement for the bubble study.

Remember: You should append modifier 26 (Professional component) to the echocardiography codes if the physician performs the procedure in the hospital. You can verify which codes have professional and technical components according to Medicare by checking the PC/TC column of the Medicare Physician Fee Schedule.

CPT's say: In response to a request for the appropriate bubble study code, AMA's June 2005 CPT Assistant says you may report 90784 (Therapeutic,prophylactic or diagnostic injection [specify material injected]; intravenous) for intravenous injection of agitated saline or contrast media for imaging during echocardiography. (Remember that CPT 2009 moved the infusion and injections codes. The appropriate code in 2009 is 96374, Therapeutic, prophylactic, or diagnostic injection [specify substance or drug];intravenous push, single or initial substance/drug).

Reality: A hospital employed nurse or echo tech may be the one injecting the agitated saline, and in that case the physician should not bill for it.

As another option, CPT Assistant suggests appending modifier 22 (Increased procedural service) to the echo code. With appropriate documentation, you may be able to receive reimbursement from non-Medicare payers using these methods.