Oncology & Hematology Coding Alert

Question: I work for an oncology practice in central Illinois. We send chemotherapy patients to a local rural hospital for baseline echocardiograms when the drug has cardiotoxic indications. Medicare is denying us payment for the echocardiograms. How can we get reimbursed?

Illinois Subscriber


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Answer: Echocardiography is a two-dimensional imaging that defines the configuration and changing dimensions of the chambers, dynamic cyclic variation in myocardial thickness, and the associated valve motions throughout the cardiac cycle. Certain chemotherapy drugs such as Doxorubicin, J9000-J9001, can have toxic effects on the heart. Medicare allows echocardiography to measure these toxic affects of chemotherapy.

Coverage includes obtaining ultrasonic signals from the heart and great arteries, with two-dimensional image and/or Doppler ultrasound signal, documentation, and interpretation of results. Medicare covers a variety of echocardiography codes. More specifically, Illinois Medicare policy says baseline echocardiograms are a covered Medicare service. These include CPT codes:

93307 echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording; complete.

93308 echocardiography, real-time with image documentation (2D) with or without M-mode recording; follow-up or limited study.

+93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete (Use 93320 in conjunction with codes 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93350).

+93321 ... followup or limited study (list separately in addition to codes for echocardiographic imaging) (Use 99321 in conjunction with codes 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93350).

+93325 Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography) (Use 93325 in conjunction with codes 76825, 76826, 76827, 76828, 93303,93304,93307, 93308, 93312, 93314, 93315, 93317, 93320, 93321, 93350).

For oncology practices, measures of myocardial contractility, thinning and dilatation are important in the titration of therapeutic agents with known myocardial toxicity. Baseline assessment which is prior to treatment, bimonthly during and at six months following therapy, is generally considered medically appropriate.

Denials for this procedure usually relate to failure to provide the proper diagnosis code or medical necessity documentation when the condition is not listed as a covered diagnosis. Code 963.1 (poisoning by antineoplastic and immunosuppressive drugs) should be listed to show medical necessity.

Answered by Cindy McMahan, CPC, a coding specialist with SVA Consulting in Madison, Wis., an accounting firm that provides medical billing and coding services to medical practices.