Once the echo is performed, and there is a diagnosis that can be used from the results of the echo, you should code only the results of the echo and not the indication(s) for the echo. Indications are sometimes very vague and some are for "rule out" and are not definitive (the patient may or may not have a TIA or a CVA...). If the echo is abnormal, but it's not crystal clear what exactly is abnormal about it, then the abnormal echo diagnosis can be used (793.2), or you can have the Doctor write an addendum to his report to give you a more definitive diagnosis. Claims should never be coded based on what is payable and what is not payable with a particular insurance company. They should be coded according to what is documented in the report. If the diagnosis is not payable, then the claim should be appealed. I'm a former claims service rep, and I feel for them, but appeals are unfortunately necessary for this reason.I am curious ?Wouldn't you post the reason for performing the echo as the primary diagnosis (possibly a payable CMS diagnosis) followed by the secondary dx as abnormal echo?