Cardiology Coding Alert

For good examples of echocardiography reports that clearly indicate Doppler pulsed or continuous wave and Doppler color flow studies, review the following actual reports provided by Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country.

1. Doppler: No Established Color Flow

 For the following report, you would bill 93307 for the complete echocardiography and add only 93320 for the Doppler portion. Because the report does not include information on color flow, you would not report 93325.
 
M-mode measurements: right ventricle (RV) (99-26) mm; interventricular septum (IVS) (6-11) 9 mm; left ventricular end diastolic dimension (LVEDD) (35-57) 47 mm; left ventricular end dimension systole (LVEDS) (20-40) 22 mm; posterior left ventricular wall (PLVW) (6-11) 8 mm; fractional shortening (FS) (30-44) 53 percent; ejection fraction (EF) (greater than 55 percent) 84 percent; aortic root (20-37) 23 mm; left atrium (19-40) 34 mm.   

Doppler examination: aortic valve: AVA cm 2; gradient peak: mmIIg mean mmHG; mitral valve (MV); mild mitral regurgitation (MR); MVA cm2; PHT m/sec; tricuspid valve: no measurement; pulmonic valve: no measurement; estimated right ventricle systolic pressure: mmHG.
 
Impression: normal left ventricular size and function; normal right ventricular size and function; normal atrial sizes; normal valvular study; no pericardial effusion or thrombus.
 
Doppler: mild mitral regurgitation.

 In this instance, you would report 93307 for the complete echocardiography, add 93320 for the Doppler study and 93325 for the color flow portion. (See underlined color flow notation.)
 
1. Good left ventricular (LV) and right ventricular (RV) systolic function. No wall motion abnormalities noted. Calculated ejection fraction 73 percent. RV and right atrium (RA) appear unremarkable. Aortic root is 3.3; left atrial enlargement (LAE) is 4.5. Mild concentric left ventricular hypertrophy in the 1.3-1.6 range. Left ventricular dimension systole (LVDS) is normal at 3.2.
 
2. Mitral and tricuspid valves appear unremarkable, pulmonic valve looks unremarkable but not well seen. Mild aortic stenosis (AS), could not see all three leaflets, but valve opens well by 2D. Color flow across pulmonic valve is unremarkable. Mitral valve has some mild sclerosis but otherwise unremarkable.

 3. No pericardial effusion.

 4. Doppler studies with trace pulmonic insufficiency (PI), 1+MR (mitral regurgitation), trace tricuspid regurgitation (TR). Pulmonary artery pressure (PAP) could not be calculated.
 
5. Aortic arch views limited but appear unremarkable.