Cardiology Coding Alert

Question: One of our cardiologists wants to do an echocardiogram on the same day as a nuclear stress test. How should I report this, and will carriers pay for this?

Kansas Subscriber

Answer: If the cardiologist decides to perform a diagnostic test, such as an echocardiogram or a nuclear study, on the same day as the office visit, you should report both the appropriate diagnostic test code and the office visit code. You should also append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code. Appending modifier 25 will tell payers that the E/M service is separate from the usual patient evaluation that is necessary before, during and after the diagnostic test.

- Same-day test example: An established patient comes in complaining of palpitations (785.1) and light-headedness (780.4). The provider performs a complete cardiac workup and orders a same-day, in-office echocardiogram.

To report the visit, bill the echo as 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete). You may need to add additional codes, depending on the equipment and the images the physician obtained.

These additional codes could include +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete [list separately in addition to codes for echocardiographic imaging]) or +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]).

Report the office visit with an E/M code, such as 99214 (the level would depend on the physician's documentation), and append modifier 25. You should add modifier 25 to the E/M code because the patient came in for a specific illness reason and the cardiologist ordered the echo as a result of the exam.