Cardiology Coding Alert

Question: Our cardiologist performed an echo on a patient and discovered a minor congenital anomaly. Should we use the congenital codes or the normal echo codes?

Massachusetts Subscriber
 
Answer: If your cardiologist does not know that a congenital anomaly exists until he performs the normal echocardiography, you should focus on congenital codes 93303, 93304 and 93315-93317 as appropriate.
 
Keep in mind: This rule remains true even if your cardiologist finds a congenital abnormality with little or no clinical significance. You should still report the congenital echocardiography codes.
 
For example, your cardiologist sets out to perform a normal echocardiogram to assess an 89-year-old patient's murmur (785.2, Undiagnosed heart murmur). The echocardiography reveals a tiny muscular VSD (745.4, Ventricular septal defect). Although the cardiologist deems the VSD clinically insignificant, you should still use the congenital echocardiography codes.
 
On the other hand, suppose the cardiologist performs an echo on a patient and discovers a patent foramen ovale that does not warrant any treatment. In this case, you would still use the congenital echo codes (93303, 93304, 93315-93317).
 
Watch out: When a patient undergoes an echocardiogram and the results do not point to congenital heart disease, you should not report the congenital echocardiography codes. You will not have justification.
 
For example, if your cardiologist suspects congenital heart disease because a physician detected a heart murmur in a newborn baby or the patient's family history suggests that a congenital anomaly might be present, he might order a congenital echocardiogram.
 
If the results do not reveal anything congenital, you must report the normal echo codes (93307, 93308, 93312-93314).