Cardiology Coding Alert

Question: The cardiologist ordered an echocardiogram-for a patient diagnosed with stenosis of the aortic and mitral valves. What would be the correct coding for this scenario? Specifically, how many ICD-9 codes should I report to reflect the patient's condition?

Arkansas Subscriber

Answer: You'll use one diagnosis code to represent the stenosis in both valves. When patients have stenosis (or another affliction) in the mitral and aortic valves, you should choose a code from the 396 series (Diseases of mitral and aortic valves) to identify both conditions.

Aortic stenosis does have its own code, 424.1 (Aortic valve disorders). But under the exclusions section for 424.1, ICD-9 states that the diagnosis does not include "that of unspecified cause but with mention of diseases of mitral valve (396.0-396.9)."

ICD-9 coding: The proper code for your claim is 396.0 (Mitral valve stenosis and aortic valve stenosis).

CPT coding: Choose from one of these ECG codes, depending on the encounter's specifics:

• 93307 -- Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording; complete

• +93320 -- ... Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete

• +93325 -- Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography).

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.