Cardiology Coding Alert

Question: We are coding from the doctors dictated echo reports. For instance, we had a patient that was admitted to the hospital for critical congestive cardiomyopathy and multiple intracardiac thrombi. Our doctor dictated that he did an echocardiogram that was two dimensional, m mode, pulse and color flow doppler then proceeded to dictate a detailed report. We coded it 93307-26, 93320-26 and 93325-26. Then he saw the patient again on three consecutive days and dictated the same thing. When reading all four reports, it looks like he actually did complete studies all four days. Are we allowed to bill four complete studies in a row?

Oregon Subscriber

Answer: Clinical indications are always necessary to show medical necessity for echocardiograms, and abrupt change in signs and symptoms causing deterioration may justify medical necessity for more frequent echoes. To bill for complete echoes on four consecutive days, however, you are going to have to be able to prove that there were significant changes and/or deterioration on every one of those days. Such a scenario, though possible, is highly unlikely, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding specialist and educator in North Augusta, S.C.

If your physician has sufficient documentation of the tests performed and worsening signs or symptoms requiring multiple transthoracic echocardiograms, he or she should be able to bill all services performed. Be prepared to send a lot of documentation, Callaway-Stradley says, noting that the big problem will be explaining why full studies were performed again and again.

It may be more appropriate to code the first day as indicated but use 93308 (follow-up or limited study) on day two, says Terry Fletcher, BS, CPC, a coding and reimbursement specialist in Laguna Beach, Calif. For days three and four, Fletcher recommends submitting 93308 codes with modifier -76 (repeat procedure by same physician) attached. Even so, Fletcher says, getting more than the first two paid will be difficult. She notes that all relevant documentation should accompany the claim to indicate the patients condition still is in flux and the physician remains uncertain about the cause.