Cardiology Coding Alert

Question: A transesophageal echocardiogram (TEE) is performed and images are obtained before surgery. After surgery, more images are obtained. Can the cardiologist bill for reading both sets of images?

Texas Subscriber

Answer: Not according to the American College of Cardiologys Guide to CPT Coding, which states, If the probe is left in place during the definitive procedure with additional images taken by the same physician post-procedure, 93312 (echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report) is reported only once. The additional images taken postoperatively are included in this code.

Many cardiologists feel they should receive additional payment for reading the postoperative images, and the service is described in 93314 (... image acquisition, interpretation and report only). But Sandy Rubio, RN, CPC, a cardiology coding specialist at Physicians Clinic, a large multispecialty practice with seven cardiologists in Omaha, notes that the national Correct Coding Initiative bundles 93314 with 93312 and has a 0 indicator on the edit, which means that even if the services are performed at different times (which could be the case here) no override of the edit is possible.

If, however, a different physician interpreted the images postoperatively and submitted a separate report, that physician could bill for the additional imaging using 93314.

If Doppler and color flow studies are performed and documented, 93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete) and 93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]) may also be billed.

Note: The ACC says modifier -77 (repeat procedure by another physician) should be appended to 99314 if another physician performs the postoperative interp. But 99314 is not a repeat procedure because the original procedure also involved placement of the probe and has a different code (93312); therefore, including this modifier may confuse some carriers.