# How to code Doppler - I have a question



## gaponte (Mar 19, 2009)

Regards, 


I have a question in regards to the revised code 93307 ("Echocardiography,, real-time with image documentation (2d), inclu transthoracic des m-mode recording, when performed, complete, without spectral or color doppler echocardiography")

underneath of it, says (do not report 93307 in conjunction with 93320, 93321, 93325)

So, how can I report a Spectra Doppler Echo? It will be perfect using 93307 with 93320 but it does not go with the CPT guidelines. Does 93307 include the 93320? Can someone please help?


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## deeva456 (Mar 20, 2009)

For 2009 to report an echocardiogram with spectra color flow you bill with 93306. Use modifier 26 if performed in an outpt hospital or inpt setting. Instead of billing an echocardiogram with 3 codes you will only bill with one.


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## gaponte (Mar 20, 2009)

*How to code Doppler Echo with Spectral for 2009?*

But code 93306 reads (Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography). And the physician did not do the color flow but did the Spectral. I think we will be over coding if we use 93306


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## Lisa Bledsoe (Mar 20, 2009)

What about mod -52?  It's unfortunate that CPT changed the guidelines when they added 99306, but based on descriptions, this is probably your only option.  Why doesn't he/she do color flow?


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## gaponte (Mar 20, 2009)

*Doppler Echo with Spectral for 2009*

He does do it with the color flow but the insurance does not pay for it, and we have to charge the member. I guess modifier -52 or unlisted will be the best option. 

Thak you for your help!!!!


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## heart123 (Mar 20, 2009)

*aetna and color flow*

when you say insurance  won't pay are you talking about aetna not paying for the color flow? and if you are, you need to code with the results from the echo  //424.0// 424.2 they pay that you just need to find the correct ldx for aetna


I have a question in regards to the revised code 93307 ("Echocardiography,, real-time with image documentation (2d), inclu transthoracic des m-mode recording, when performed, complete, without spectral or color doppler echocardiography")

underneath of it, says (do not report 93307 in conjunction with 93320, 93321, 93325)

So, how can I report a Spectra Doppler Echo? It will be perfect using 93307 with 93320 but it does not go with the CPT guidelines. Does 93307 include the 93320? Can someone please help?[/QUOTE]


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## LOVE2CODE (Mar 21, 2009)

angelcleg said:


> when you say insurance  won't pay are you talking about aetna not paying for the color flow? and if you are, you need to code with the results from the echo  //424.0// 424.2 they pay that you just need to find the correct ldx for aetna
> 
> 
> I have a question in regards to the revised code 93307 ("Echocardiography,, real-time with image documentation (2d), inclu transthoracic des m-mode recording, when performed, complete, without spectral or color doppler echocardiography")
> ...


[/QUOTE]


OK...I have been asking this question for about a month and no one did not respond....So I went to the Chair of Cardiology yesterday and he explain it to me.  Here it is...Very Simple

2009 charges

Bill 93306 alone 

Bill 93307 alone

Bill 93312-26, 93320-26, and 93325 -26/59 (TEE) ; you can't bill these charges w/93306 or 93307 in 2009.

Hope this helps because I was really confused until yesterday.


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## gaponte (Mar 23, 2009)

thank you


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## jcruz (Mar 30, 2009)

Does this also include Pedi patients that are being examined for congenital cardiac anomalies?   In the past the Cardiologist has billed 93303 or 93304, 99320 and 99325...


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## deeva456 (Mar 30, 2009)

Hello jcruz,

For 2009, billing an echocardiogram for congenital anomalies has not changed. You would continue to bill 93303 or 93304 with 93320 & 93325.

Dolores, CPC, CCC


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## jcruz (Mar 31, 2009)

We have been doing this and are having the 93325 denied as bundled with the 93320.  Modifier 59 really does not seem appropriate since it is not a separate session or part of the anatomy.  It however is a different procedure.
Any thoughts...


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## Cuteyr (May 13, 2009)

I too have a doubt in this combination.
Why is that we are getting denials when we code 93312,93320 and 93325.
We get denials mostly for 93325
Any one to help????


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## jcruz (May 13, 2009)

Unfortunately it is denying because of the 93320. Look at what your physician is documenting and review the codes. If the documentation supports both of the two codes, I would bill for the procedure with the higher reimbursement.  It is crazy that this is all of a sudden getting denied.


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## mshelly87 (May 13, 2009)

*limited echo*

What if you do a limited echo 93308? I am getting denied when our tech does doppler and color flow 93221 and 93225. I keep getting an error message from medicare saying primary procedure not found. Also when we do stress echo in the office 93351 and our tech does doppler and color flow 93320 93325 i am getting the same message. Any thoughts


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## KGerlings (Jun 17, 2009)

According to Dr. Z... CCI edits made a mistake bundling 93320 and 93325. This will be changed back on the next release of CCI edits. For now, they suggest putting a -59 on 93225. It has worked for us.


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## efuhrmann (Jun 23, 2009)

*NCCI error*

who is Dr. Z and can anyone cite a reference for the revision to the 93320/93325 bundle issue?


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## eglaham (Jun 29, 2009)

*NCCI Error*

I am looking for the same reference from CMS.  Dr. Z is www.zhealthpublishing.com.


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## GS5174 (Jul 13, 2009)

I asked CMS for help on this same situation.  This was their reply.

-----Original Message-----
From: CMS Website Questions [mailto:cms@custhelp.com]
Sent: Wednesday, June 24, 2009 1:15 PM
To: CMS ProviderFeedback
Subject: Coding Feedback

The following question has been received:

Contact Information
---------------------------------------------------------------
    Email Address: gayla.sharpe@wfhc.org
       First Name: Gayla
        Last Name: Sharpe
Reference #090624-000027
---------------------------------------------------------------
            Product Level 1: Medicare
  Product Level 2: Coding
  Product Level 3: National Correct Coding Initiatives Edit
     Date Created: 06/24/2009 01:14 PM
     Last Updated: 06/24/2009 01:14 PM

Discussion Thread
---------------------------------------------------------------
Customer - 06/24/2009 01:14 PM	
If we are only performing part of the services in CPT 93306 (TTE with color flow) and not using spectral display, how can we bill for it if 93320 & 93325 bundle into 93307 with no modifier allowed? Would it be appropriate to use 93306-52?


-----Original Message-----
From: CMS ProviderFeedback
Sent: Wednesday, June 24, 2009 3:37 PM
To: CMS CMMInquiry
Cc: CMS ProviderFeedback
Subject: FW: Coding Feedback

Thank you for your e-mail inquiry regarding coding for services using CPT 93306 and possible modifiers.

After consulting with our coding analysts, it was decided that the services you described should be coded as CPT 93306-52 (modifier).


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