Wiki Echocardiogram Limited vs Complete

[nserr0319@gmail.com]

Hello,
We are tryingt to figure out the guidelines for echocardiogram billing for a complete study on a patient that has had previous studies.
When a complete study is done is there a timeline (ie-after one year from previous) that we can bill for a complete study again?
Does it go by insurance guidelines? Is there anywhere I can find more information on echocardiogram coding and billing?
Thank you!!

 

[Misty Dawn]

Hello,
We are tryingt to figure out the guidelines for echocardiogram billing for a complete study on a patient that has had previous studies.
When a complete study is done is there a timeline (ie-after one year from previous) that we can bill for a complete study again?
Does it go by insurance guidelines? Is there anywhere I can find more information on echocardiogram coding and billing?
Thank you!!

Diagnostic studies can be performed/coded as many times as medically necessary. It is always good idea to be familiar with your specific insurance guidelines but I have never seeing where there was a limit on how often a complete echo can be performed as long as medically necessity is documented. For CMS 93306 has an MUE value of 1. It is not often but not uncommon to see a complete echo done twice on the same day. For example: pt comes to hospital with chest pain. Finding are CAD; pt has coronary stent placed. In recovery the pt complains of new/worsening chest pain. a second complete Echo is performed due to the new chest pain. Complete echo code would be coded twice using the appropriate modifier as needed for two complete echos performed on the same day (as long as the views and techniques as outlined in the CPT are documented...see on pg 618-619 in your 2017 CPT book). No modifier would be needed if performed on separate day. ([FONT=&quot]MUE MAI "1" indicates a claim line edit. When it's appropriate to report units that exceed the MUE, use one or more additional claim lines with an appropriate modifier appended to the code. Payers who apply the MUE will process each claim line separately for payment.)


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[jwilding@san.rr.com]

93306 exceed MUEs

What is the appropriate Modifier used for 93306 when multiple Echos are done in one day and has exceeded MUE of 1? We have conflicting information to use MOD 59, or 76/77 (depending on same or other MD). Thanks.