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Thread: Hosp Echo 93306-26

  1. #1
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    Default Hosp Echo 93306-26

    Good Morning everyone

    One of my docs came to me yesterday stating that he was under the impression that hosp echoes done within the last 6 months should be billed at a follow up echo. I do not agree with this. As we all see, patients come in and out of the hospital, and its not always for the same reason. If the patient has presented with new symptoms, and a complete echo was performed, why bill for a follow up? Any opinions would be great. I've searched for info regarding this exact question on Medicare's site and couldn't find anything.
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  2. #2
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    Default

    Quote Originally Posted by jlb102780 View Post
    Good Morning everyone

    One of my docs came to me yesterday stating that he was under the impression that hosp echoes done within the last 6 months should be billed at a follow up echo. I do not agree with this. As we all see, patients come in and out of the hospital, and its not always for the same reason. If the patient has presented with new symptoms, and a complete echo was performed, why bill for a follow up? Any opinions would be great. I've searched for info regarding this exact question on Medicare's site and couldn't find anything.
    I agree with you. I've been questioned about this once before and I never found anything myself. I keep billing for complete studies. If anybody has anything in writing about this, I'd love to know.

    Jessica CPC, CCC

  3. #3
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    Default 93306 verses 93307

    Are either of you familiar with the what is required in the documented report to difference between 93306 (w/ spectral Doppler echo, and w/ color flow Doppler echo) verse 93307 (w/o spectral and w/o color flow) what is the difference in the documentation?

    I thought that it would be that the doctor would mention the use of spectral Doppler and the color flow Doppler as technique used, but I've been informed that I am confused regarding this by said doctor. I've been looking for examples of documentation for both so that I can identify the differences.

    thanks

  4. #4

    Default

    Quote Originally Posted by LauraMilazzo View Post
    Are either of you familiar with the what is required in the documented report to difference between 93306 (w/ spectral Doppler echo, and w/ color flow Doppler echo) verse 93307 (w/o spectral and w/o color flow) what is the difference in the documentation?

    I thought that it would be that the doctor would mention the use of spectral Doppler and the color flow Doppler as technique used, but I've been informed that I am confused regarding this by said doctor. I've been looking for examples of documentation for both so that I can identify the differences.

    thanks
    I agree with you all that a new problem would not be a followup. On the difference between the 93306 and 93307. 93306 needs to mentioned the doppler and colorflow was used. 93307 would not mention it. Hmm how are you confused sound right on to me? I like to see when it says Doppler then the results of the Doppler. For Colorflow just the mention is good enough.
    Theresa CCS-P CPMA CCC ICDCT-CM

  5. #5
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    Smile

    In our cardiology office, we have had a physician question us as well. We need specific documentation guidelines for Echos. Also, we would like to know, where we can get information on what each measurement on an echo means. i.e. LVOT area: 2.8 cm.

    Any web-site links to use for our own research would be greatly appreciated.

    Thanks!

  6. #6

    Default

    Quote Originally Posted by lcterry View Post
    In our cardiology office, we have had a physician question us as well. We need specific documentation guidelines for Echos. Also, we would like to know, where we can get information on what each measurement on an echo means. i.e. LVOT area: 2.8 cm.

    Any web-site links to use for our own research would be greatly appreciated.

    Thanks!
    If you look at the code for echo say 93306. Read what it tells you before under "Echocardiography" in your CPT book. It tells you all the documentation requirements and what makes up a "complete" echo. Tells you for complete you need all three valves reported on, left, right atrium, left, right Ventricle, etc.
    Theresa CCS-P CPMA CCC ICDCT-CM

  7. #7
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    Default

    Quote Originally Posted by theresa.dix@ethc.com View Post
    If you look at the code for echo say 93306. Read what it tells you before under "Echocardiography" in your CPT book. It tells you all the documentation requirements and what makes up a "complete" echo. Tells you for complete you need all three valves reported on, left, right atrium, left, right Ventricle, etc.
    Yes it does tell you what areas need to be documented for a complete echo, but please keep in mind that there are two codes for a complete echo: 93306 is a complete echo with spectral and color flow doppler; 93307 is a complete echo without spectral or color flow doppler.

    In order to bill the 93306 the documentation for a complete echo as well as documentation to support spectral doppler & color flow doppler must be in the report.

  8. #8
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    Default

    Quote Originally Posted by jlb102780 View Post
    Good Morning everyone

    One of my docs came to me yesterday stating that he was under the impression that hosp echoes done within the last 6 months should be billed at a follow up echo. I do not agree with this. As we all see, patients come in and out of the hospital, and its not always for the same reason. If the patient has presented with new symptoms, and a complete echo was performed, why bill for a follow up? Any opinions would be great. I've searched for info regarding this exact question on Medicare's site and couldn't find anything.
    I too disagree with your physician. The CPT book states "A follow-up or limited echocardiographic study (93308) is an examination that does not evaluate or document the attempt to evaluate all the structures that comprise the complete echocardiographic exam. This is typically limited to, or performed in follow-up of a focused clinical concern."

    The key wording here is "a focused clinical concern". For example a patient presents to the hospital for shortness of breath. A complete echo confirms pericardial effusion. A pericardiocentesis is performed followed by a second echo to evaluate the status of the pericardial effusion. The second echo would be considered a follow-up study.

    Our office will bill a complete study for hospital echos (even during the same inpatient stay) when evaluating the overall structure/function of the heart due to a change in clinical status. For example, a patient presents to the hospital for shortness of breath. A complete echo is performed and found to be normal. The patient is found to have pneumonia. A few days later the patient complains of severe chest pain. A second complete echo is performed to evaluate the overall structure/function of the heart and rule out any cardiac complications. The second echo would be billed as a complete study not a follow-up study.

  9. #9

    Wink

    Quote Originally Posted by PRICEOR View Post
    I too disagree with your physician. The CPT book states "A follow-up or limited echocardiographic study (93308) is an examination that does not evaluate or document the attempt to evaluate all the structures that comprise the complete echocardiographic exam. This is typically limited to, or performed in follow-up of a focused clinical concern."

    The key wording here is "a focused clinical concern". For example a patient presents to the hospital for shortness of breath. A complete echo confirms pericardial effusion. A pericardiocentesis is performed followed by a second echo to evaluate the status of the pericardial effusion. The second echo would be considered a follow-up study.

    Our office will bill a complete study for hospital echos (even during the same inpatient stay) when evaluating the overall structure/function of the heart due to a change in clinical status. For example, a patient presents to the hospital for shortness of breath. A complete echo is performed and found to be normal. The patient is found to have pneumonia. A few days later the patient complains of severe chest pain. A second complete echo is performed to evaluate the overall structure/function of the heart and rule out any cardiac complications. The second echo would be billed as a complete study not a follow-up study.

    Well said!
    Theresa CCS-P CPMA CCC ICDCT-CM

  10. #10
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    Talking

    Quote Originally Posted by PRICEOR View Post
    I too disagree with your physician. The CPT book states "A follow-up or limited echocardiographic study (93308) is an examination that does not evaluate or document the attempt to evaluate all the structures that comprise the complete echocardiographic exam. This is typically limited to, or performed in follow-up of a focused clinical concern."

    The key wording here is "a focused clinical concern". For example a patient presents to the hospital for shortness of breath. A complete echo confirms pericardial effusion. A pericardiocentesis is performed followed by a second echo to evaluate the status of the pericardial effusion. The second echo would be considered a follow-up study.

    Our office will bill a complete study for hospital echos (even during the same inpatient stay) when evaluating the overall structure/function of the heart due to a change in clinical status. For example, a patient presents to the hospital for shortness of breath. A complete echo is performed and found to be normal. The patient is found to have pneumonia. A few days later the patient complains of severe chest pain. A second complete echo is performed to evaluate the overall structure/function of the heart and rule out any cardiac complications. The second echo would be billed as a complete study not a follow-up study.
    Thank you!!!! That's exactley how I bill them too!! Glad to know I'm not the only one alone here.......lol.
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

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