Cardiology Coding Alert

Question: My practice just started doing bubble studies in the office, and I'm not sure which injection codes I should use.


Tennessee Subscriber

Answer: For non-Medicare payers, report 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous) for the injection.

You should also include the appropriate 2-D echocardiogram code (93307-93308) and Doppler and color flow studies (93320/93325) if performed and documented. 

Note: Medicare previously took the position that this injection is not separately payable even though it is not a routine part of a traditional echocardiographic study.
 
Bubble studies involve injecting agitated saline (saline with "bubbles" in it) into the blood stream to look for problems such as atrial septal defects. You can also report your provision of the saline with the code preferred by your individual payers: J7051 (Sterile saline or water, up to 5 cc) or A4216 (Sterile water/saline, 10 ml)

You might find, however, that the effort necessary to receive reimbursement for this supply is not worth the time/effort necessary to secure payment. Many practices have to appeal denials for this supply code, which typically generates about $2 in reimbursement.