Coding Accurately for Echocardiography Services

Coding Accurately for Echocardiography Services

To ensure appropriate reimbursement for ECG studies, providers need to submit accurate codes, modifiers, and claims for services rendered.

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Echocardiography (electrocardiogram) or the ECG test is an effective diagnostic tool that uses ultrasound for the initial evaluation of many cardiac signs and symptoms. ECG provides an excellent view of the cardiovascular system. It provides speedy clinically relevant data costeffectively and with least stress to the patient. Echocardiography can be completed more quickly than other imaging techniques. When it comes to reporting echocardiography procedures, coding accurately is critical. In the current scenario of declining reimbursement and increased scrutiny, Outsourced medical billing services are a practical option for claims processing and payment management.

The electrocardiogram can show:

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cardiac structure -- the size and shape of cardiac chambers

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coronary artery disease and heart muscle disease

function and morphology of cardiac valves – how well the heart is working presence of a blood clot

In patients already having cardiac disease, ECG is used to assess severity, evaluate the results of medical and surgical interventions, and guide procedures. It is also used in the evaluation of patients with electrolyte abnormalities, drug toxicities, and implanted defibrillators. Echocardiography is also an important tool to diagnose congenital and acquired heart problems in infants and children.

Coding and Billing Echocardiography The American Society of Echocardiography (ASE) and the American Medical Association (AMA) continually review the Current Procedural Terminology (CPT) and revise and add new codes. To ensure appropriate reimbursement for ECG procedures and visits, practitioners need to stay up-to-date with the changes and submit accurate codes, modifiers, and claims for services rendered. The following is a list of CPT codes used to report echocardiography in 2019: Echocardiogram CPT Codes 2019 93350 transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, during rest and cardiovascular stress test

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using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report 93351 transthoracic, real-time with image documentation (2D), includes Mmode recording,‌; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete 93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study 93306 Transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography 93307 transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, complete, without spectral or color Doppler echocardiography 93308 Transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, follow-up or limited study 93312 Transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report 93313 transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only 93314 transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only 93315 for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report 93316 for congenital cardiac anomalies; placement of transesophageal probe only 93317 for congenital cardiac anomalies; image acquisition, interpretation and report only www.outsourcestrategies.com

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93318 transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis 93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete 93321 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); follow-up or limited study (list separately in addition to codes for echocardiographic imaging) 93325 Doppler echocardiography color flow velocity separately in addition to codes for echocardiography)

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93350 transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report 93351 transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional 93352 Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure) 93355 Transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg, TAVR, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intra-procedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic

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transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D. Code Selection Whatever the ultrasound equipment used, the physician should choose the code that correctly describes the echocardiography exam performed and the corresponding reason for the study (www.sonosite.com). The services rendered must be documented in the patient's record.

93306 vs. 93308 When it comes to choosing the right echocardiography code, there is often confusion about codes 93306 vs. 93308. The distinction between these codes can be understood by carefully reviewing the descriptors.

Code 93306 describes a complete transthoracic echo with Doppler and color flow.

According to CPT guidelines, “a complete transthoracic echocardiogram requires 2-dimensional and, when performed, selected M-mode examination of the left and right atria, left and right ventricles, the aortic, mitral and tricuspid valves, the pericardium and adjacent portions of the aorta. (Note that while M-mode exam is usually performed, it is not required in order to assign a complete echo code.) If it is impossible to image all of the listed structures, the report must indicate the reason. A limited transthoracic echocardiogram should be billed if the report does not evaluate or attempt to evaluate all of the structures listed above�.

CPT code 93308 represents a limited or follow up study: 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study. This does not evaluate (or document the attempt to evaluate) all the structures that comprise the complete echocardiographic exam, as outlined in the CPT criteria, above. A limited study is typically confined to, or performed in follow-up of, a focused clinical concern.

CPT Assistant (September 2005) also advises: [echo] “whether complete or limited, includes an interpretation of all obtained information, documentation of all clinically relevant findings including quantitative measurements obtained, plus a description of any recognized abnormalities. Pertinent images, videotape, and/or digital data are archived for permanent storage www.outsourcestrategies.com

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and are available for subsequent review. Use of echocardiography not meeting these criteria is not separately reportable.�

Proper documentation is critical to ensure accurate code assignment.

Providers must also retain permanent images in the patient's record in order to meet the criteria for billing echocardiography CPT codes. Outsourcing medical billing and coding tasks to an expert medical billing company can ensure claim submission to meet payer regulations and guidelines, which is crucial for appropriate reimbursement.

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