Cardiology Coding Alert

Question: My cardiology practice is receiving denials for 93325 from Aetna. I have told my physicians to document "color flow" or "color flow velocity mapping," but they are not the best at complying with that request. One doctor said that the color flow determines the direction of blood flow and whether there is a leakage or a hole, so if they note regurgitation or patent foramen ovale (PFO), I should bill 93325. Is this true? What documentation should I look for to bill 93320?


New Jersey Subscriber

Answer: You're right about getting your cardiologists to document their claims with specific terms. To know the correct codes to use, you need to be sure exactly what kind of echo your cardiologist performs.

If your cardiologist performs a color flow, you should report +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]). You should report 93325 only when your cardiologist specifically establishes that he performed a color flow study.

Challenge: The documentation challenge is that the cardiologist also evaluates valvular regurgitation by the pulsed wave Doppler study (+93320, Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete).

Note: The cardiologist may not be able to visualize valvular regurgitation without a color flow study, but he may be able to quantify valvular regurgitation by using nothing but Doppler data. This is not the norm, but you should note the possibility. 

If a report states, "The Doppler study reveals moderate mitral regurgitation," an auditor may give credit for the Doppler -- but not the color flow study. To be safe, the report should specifically contain findings of the color flow study. Most cardiologists agree that full evaluation of valvular function requires a color flow study. Many do not specifically mention the findings of the color flow in their reports, so you should encourage your cardiologists to note this clearly.

Best bet: You should demonstrate the patient's aortic valve problem by sending a paper bill and attach the cardiologist's report.

Be aware: Some payers have medical coverage policies for the add-on services (93320 and 93325) that include a different listing of covered diagnoses than the two-dimensional echo code (93307). Your denials may be based on diagnosis coding, so be sure to check your payers' rules for reporting 93320 and 93325.