Cardiology Coding Alert

Correctly coding Doppler echocardiography depends on determining which Doppler study the cardiologist performed along with the basic echocardiogram and whether he or she clearly indicated medical necessity for the Doppler in the report. According to CMS, Doppler echocardiography ranks at the top of the list of the most-performed cardiac diagnostic tests, but the procedure continues to present coding and billing challenges. CPT designates Doppler echocardiography codes as add-on codes, which should be used in addition to codes for echocardiography imaging: +93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete +93321 follow-up or limited study +93325 Doppler echocardiography color flow velocity mapping. CPT further specifies that you cannot report Doppler codes 93320-93325 without an accompanying echocardiography code. What Is Echocardiography? In echocardiography imaging, ultrasound waves rebound or "echo" off the heart muscle, creating an image of the valves and chambers and showing the flow of blood through the heart.

Doppler echocardiography employs a special microphone that allows technicians to measure and analyze the direction and speed of blood flow through blood vessels and heart valves.

Typically, during echocardiography studies, the cardiologist may need to use pulsed wave and/or continuous wave Doppler with spectral display and/or Doppler color flow velocity mapping, says Cynthia Swanson, RN, CPC, a coding consultant with Seim, Johnson, Sestak and Quist in Omaha, Neb.

The additional testing through Doppler technology can provide further information about a patient's condition or quantity/complexity of the cardiac problem, Swanson says.

For instance, if a patient has a Doppler as part of an echocardiography study, such as two-dimensional echocardiographic imaging (93307, Echocardiography, transthoracic, real-time with image documentation [2-D] with or without M-mode recording; complete), you would add either 93320, 93321 or 93325 to 93307, depending on whether the patient had pulsed wave and/or continuous wave or color flow velocity mapping, Swanson says.

Distinguish Between Waves and Color Flows

Doppler pulsed wave/continuous wave studies and Doppler color flow velocity mapping generate different results, so coders should code the procedures separately.

Code 93320 describes pulsed wave and/or continuous wave Doppler with spectral display. The advantage of the pulsed wave (PW) Doppler is that it calculates blood-flow velocity, direction and spectral characteristics from a specified point in the heart or blood vessel, Swanson says The main disadvantage is that the maximum velocity the cardiologist can measure is limited because the pulse repetition frequency is limited.

Continuous wave (CW) Doppler uses dual crystals so ultrasound waves can be simultaneously and continuously sent and received, Swanson says. There is no maximum measurable velocity with CW, so the physician can measure high-velocity flows. The disadvantage with CW Doppler is that sampling of blood-flow velocity and direction occurs all along the ultrasound beam, [...]