Cardiology Coding Alert

Question: I seem to be having some trouble explaining to my cardiologist how to document for color flow when done with an echocardiogram. If he mentions "mitral valve regurgitation," he says that means color flow because you cannot see regurgitation without color flow. Same thing with a myocardial perfusion scan with wall motion. He says that if he mentions hypokinesia, that is the same thing as wall motion. Is he right, or does he have to state exactly what the CPT code definition is?


Texas subscriber

Answer: In order to report +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]) for color flow with echo studies, your cardiologist must establish definitively in his documentation that he performed this study.

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