93312 vs 93315

gnp001

Networker
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47
Location
Maryville, TN
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Hi all, I'm new to cardiovascular coding and am trying to figure out the difference between the two codes above, and whether adding 93320 and 93325 is appropriate. I appreciate any help.


Also I've recently gotten quite a few denials from Medicare for 93306 (performed in office) and we have met the documentation requirements and have dx that are listed on our local LCD.

I appreciate any feedback, I want to make sure I'm coding the TEEs appropriately.

Many thanks!
 

jlb102780

Guru
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126
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Jacksonville, FL
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I'm glad this subject was up.

I had one of my doctors call me today and tell me that he heard if the diagnosis was for congenital anomalies, then we should bill the 93315 regardless. Now his reason for this is because the RVU's are higher on the 93315 vs the 93312. I don't really like this for an answer. I've been trying to find the billing guidelines between the 93312 and the 93315 and I'm having a hard time. I've found the LCD for the codes, but it doesnt state the difference in billing the two. Any help would be awesome :)
 

kmuerth

Networker
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50
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Fort Myers, FL
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dont use any cpt codes for congenital cardiac anomalies unless you have proof/documentation in the chart that the patient already has an anomaly. otherwise stick with 93312 until proven.
 
Messages
626
Location
Seymour, TN
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I'm glad this subject was up.

I had one of my doctors call me today and tell me that he heard if the diagnosis was for congenital anomalies, then we should bill the 93315 regardless. Now his reason for this is because the RVU's are higher on the 93315 vs the 93312. I don't really like this for an answer. I've been trying to find the billing guidelines between the 93312 and the 93315 and I'm having a hard time. I've found the LCD for the codes, but it doesnt state the difference in billing the two. Any help would be awesome :)
Heres the deal on this.
If the doc does not know a congenital anomaly exsists until he performs the echo, you can use the congenital code. If he sets out thinking there is an anomaly and he finds there is not you should use the non congenital code. So it is based on the findings of the echo.

The congenital echo is more money but you better not base your coding on the rvu's!
 
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