93312, 93315 or 93313, 93316 codes have both TC and Professional components. I think (this is my opinion here) that if the physician coded 93315.26 and the Tech coded 93312 then this would cause denial. I think the procedure performed/CPT code on the claims should match between the two. I think you are on the right track here and if there is only professional 93315 built in the system then they probably need to add the technical to use.
I disagree with the statements above that if the congenital is not known before the exam to use CPT 93312. The code assigned should be based off of the result/report not the orders. I have never seeing this referenced anywhere. Can anyone direct me to a reference? The below references I have support coding a congenital echo either known or found during the course of the study. See below references.
Zhealth 2015 Diagonsitic & Interventional Cardiovascular coding reference pg. 540 & 541 notes:
7. Codes 93315, 93316 and 93317 are reported when the transesophageal echocardiography is provided to infants, children or adults for when congenital heart disease is known
or found during echocardiography. In cases where congenital heart disease is suspected, but is not found, the non-congenital codes should be reported.
AAPC Coder: Code Connect
Pediatric Echocardiography for Congenital Anomalies. CPT? Assistant.
August 2013; Volume 23: Issue 8
Question: A patent ductus arteriosus (PDA) was diagnosed during the pediatric years and the child had surgery to correct the defect. The child is now an adult and another unrelated heart condition is suspected. Would a congenital echocardiography code be reported, or would it be appropriate to report a noncongenital echo code?
Answer: If the results of the echocardiogram do not indicate a congenital heart anomaly but rather an acquired cardiac condition, a noncongenital echo code would be reported.
If the results indicate a congenital heart defect other than the corrected PDA, a congenital echo code would be reported.
Question: An adult patient who is status post ventricular septal defect (VSD) repair as a child is now having a transthoracic echocardiogram because of episodes of shortness of breath. Is a congenital echocardiography code appropriate to report?
Answer: Not necessarily. If the TEE is negative and no abnormalities is found, a noncongenital echo code should be reported.
2015 AMA/ACC CPT reference quide pg 223 further defines the diagnosis that should not be used with 93303, 93304 and 93315-93317. The reference notes that you should not use the congenital echo codes with simple congenital anomalies such as PFO or bicuspid aortic valve or when complex congenital is suspected but not found.
Misty Sebert CPC, CCC, CCVTC
https://www.linkedin.com/in/mistysebertcardiologycoder