Cardiology Coding Alert

You could be losing about $100 in Medicare reimbursement every time you fail to report the color flow portion of a two-dimensional echocardiography test and more than $70 when you don't bill for the Doppler not to speak of losing out on untold third-party-payer dollars.
 
What can you do to correct this bleak scenario? Hint: It's easy.
 
Cardiology coders may be reluctant to bill for the Doppler and color flow portions of two-dimensional (2D) echocardiography studies because the documentation does not support that the physician performed these add-on services, says Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country.
 
But solving the problem is relatively simple, Collins says. By adjusting the protocol for echocardiography reports to include specific details on Doppler and color flow, you'll provide a better tool for echo technicians and physicians to use as they record information to establish definitively that they performed these services, he says.

Directly Reference the Terms

 Physicians should include a short portion or statement in the echo report in which they specifically use the terms "Doppler" or "color flow," says cardiology consultant Jeff Eckert, MBA, CFM, CMA, president of MediCo Unlimited in Overland Park, Kan. Including "Doppler" and "color flow" as checklist items on the encounter or office procedure form will prompt the echo technician or physician to remember to mark that these procedures were done, thereby aiding the physician in preparing the final report, he adds.
 
For Doppler pulsed wave echocardiography, you should report +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete) with 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete) for the 2D echo study.
 
For color flow velocity mapping, report +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]) with 93307 for the echo study. Both 93320 and 93325 are separately billable with 93307, according to the American College of Cardiology's (ACC) Guide to CPT 2003.
 
Indeed, to justify Medical billing a Doppler pulsed wave and/or continuous wave study (93320), the report should show Doppler measurements, which will most likely include data on valvular regurgitation or insufficiency, Collins says. For instance, if the echo report lists Doppler measurements and states that the patient has moderate valvular regurgitation or stenosis, this would be enough to justify billing the Doppler pulsed wave study.

 This information alone, however, would not be enough to support definitively that the physician performed both Doppler and color flow velocity mapping (93325), Collins says. The provider should specifically reference performing color flow by describing blood flow mapping (imaging). Several types of mapping are available, says Cynthia A. Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist in Omaha, Neb. "Many color flow systems record blood flow toward the ultrasound transducer as red and blood flow away as blue. This color coding accentuates differences in relative velocity of flow." The echo report may document the presence of multiple velocities and directions of flow as indicated by different maps, which use brightness and color, she says.

Send Back Insufficient Reports

Coders should show physicians incomplete echocardiography reports, pointing out the need for the appropriate information for billing Dopplers and color flows, Swanson says. Implement these echo audits as part of your practice's ongoing physician billing education and reinforcement program. This might mean revamping an existing software program that is part of the echo equipment package or changing the physician's dictation format for these reports to include vital Doppler and color flow data, she says.
 
Keep in mind that an outside person (Medicare auditor or payer reviewer) must be able to pick up the report information and determine immediately that the physician provided these add-on services, Swanson says.
 
Some payers may continue to inappropriately bundle reimbursement for Doppler services into the basic echo service, but these studies should be reported separately, the ACC's guide states.
 
Don't forget to indicate medical necessity for Doppler studies by linking the appropriate ICD-9 code to the study, Swanson says. Many Medicare carriers have published local medical review policies on echocardiography services, so coders will need to check carrier guidelines for covered services.