Wiki 93312 vs 93315 facility charge

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Chlrtrep

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In our hospital echocardiograms/ TEE are performed. When a TEE is performed and a congenital anomaly is found the tech still charges the procedure with code 93312. I asked why he did not charge 93315 and he stated that is a physician only code ( professional only) and they charge all their TEE's as 93312.

My question is .....I thought you were to change the code to a congenital if there was documentation or a new finding. But is that only for professional billing?
 
93315 is not a physician only code, it is the same as 93312 except that it is for congenital anomalies. the catch is that if a TEE is performed without any knowledge of a congenital defect and one is found during the TEE then 93312 is appropriate. 93315 is only appropriate when patient has a known defect and TEE is performed to evaluate it. the extra reimbursement for 93315 is for the extra work involved in looking at the congenital defect.
 
93315 is not a physician only code. The difference is if you knew this was congenital prior to the procedure. If you did not know the patient had a congenital condition then I agree with the 93312, however if the patient has a known congenital heart abnormality then you must use the 93315
 
mitchellde said:
93315 is not a physician only code. The difference is if you knew this was congenital prior to the procedure. If you did not know the patient had a congenital condition then I agree with the 93312, however if the patient has a known congenital heart abnormality then you must use the 93315
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Okay so it looks like I had misinformation regarding 93315 to code regardless if you know there is a congenital anomaly or not. I was told if there is one even after ..you code 93315.

So why I am confused is this cpt code 93315 is not associated with any procedure charge in the entire system(14 hospitals) When I inquired about this I was also informed this code/charge was built for professional billing only.

So I am assuming it was decided to bill all TEE as 93312. I am still awaiting more information. I just wanted to hear some other opinions..

Thank you for the feedback....
 
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
 
Thanks for the reply Misty..... Your post is the same as I was thinking and the references you posted are similar to what I had read. However, I do not seem to get the same agreement from others in the organizations. We are having continued discussion.
 
AAPC 2013

A basic rule of thumb is that when a congenital echo is ordered, but a congenital anomaly is not detected, use the regular echo code (93306). If a congenital echo is ordered and a defect is detected, use the congenital code (93303). Conversely, when a regular echocardiogram is ordered and a congenital anomaly is detected, turn to the congenital code (93303).
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This is very interesting and definitely the first I've heard about it. I know we originally got our info about coding congenital echos from Jim Collins at cardiology coder but that was several years ago. This new article definitely gives it new consideration and worth discussing further with the other coders in the office.
 
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