# Echocardiogram/Exercise Stress Echocardiogram



## NESmith (Jan 10, 2012)

Please help. I have a provider who did a Echo on Day 1:
Indications: Abnormal EKG
2D Doppler Echo with Color Flow Interpretation:
A 2D Doppler echo with color flow was performed with good technical quality.
M-Mode Measurements:
Left Atrium    41 mm     RV End Diastole *
Aortic Root    34 mm     IVS wall thickness 11 mm
LV End Diastole 54 mm  Post wall thickness 11 mm
LV End Systole 34 mm   Ejection Fraction 60%
2D Echocardiogram Interpertation:
Global left ventraicular ejection fraction is normal; calculated 60%. left atriun is dilated. The rest of the cardiac chambers are normal in size. Aortic valve is sclerosed. Mitral valve is slightly thickened. Tricuspid valve appears normal. Pulmonic valve appears normal. Visualized ascending aorta appears unremarkable. Pericardial structures are normal. Inferior vena cava is normal.
Doppler & Color Flow Doppler Interpretation:
Aortic valve is normal. Pulmonary valve is normal. Mitral valve has mild regurgitation. Tricuspid valve has mild regurgitation..
Impression:
1. Normal left ventricular ejection fraction.
2. Midly dilated left atrium.
3. Diastolic dysfunction.
4. No hemodynamically significant valvular abnormalities.
CPT code billed.99306

Day 2 provider did;
Exercise Stress Echo
Indication For Study: Abnormal EKG
Interpretation Rest:
Resting left ventricular ejection fraction is normal. There are no regional wall motion abnormalities. There are no significant structural valvular abnormalities. The resting EKG demonstrated no substantial ST-segment depression.
Interpretation Stress:
Patient exercised on the Bruce Protocol for 6:00 minutes and :32 seconds, achieving a work load of 7.7 METS and a maximum heart rate of 170 beats per minute, which is 110% maximum predicted heart rate. There was no significant Dysrhythmia. At peak exercise there was no significant ST abnormalities. there were no EKG changes in the inferolateral leads.
Immediately after exercise, echocardiographic images demonstrated normal augmentation of left ventricular ejection fraction. There is no significant exercise induced segmental regional wall motion abnormalities.
Conclusions:
1. Technically difficult study.
2. No evidemce of ischemia on current study.
CPT code billed 93351.
I am new to coding cardio procedures and the insurance company is denying Day 2. Please help me understand why the provider would do one procedure on one day and another one on the other. Maybe it is I just need help understanding the reports. Thanks for the help.


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## Cyndi113 (Jan 11, 2012)

I can see why they would deny. Was there truly another abnormal EKG on the 2nd day to justify the 2nd echo? Can you query the physician to see if there were any other significant changes on day 2 that you can code to help justify the 2nd echo. Otherwise, I'm sorry. You can try appealing the decision but I don't think you would have any luck with it.


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