Cardiology Coding Alert

Overlooking add-on codes may cost you You can collect the $550 you deserve for transthoracic echocardiography (TTE) services -- but only if you identify and properly assign your base code and add-on codes.

Cardiologists frequently use TTE with Doppler echocardiograms to evaluate heart function and great-vessel anatomy. Because of these services' rapid proliferation and noninvasive testing approach, carriers fear that practices might overuse these codes, and therefore subject them to separate, specific policies. 93307 Represents Complete TTE Typically, when the cardiologist performs a TTE that uses ultrasonic signals and two-dimensional imaging to examine potential valvular and chamber disorders, you should report 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete), says Sheldrian LeFlore, CPC, a cardiology coding consultant with Gates, Moore & Company, a medical consulting firm in Atlanta. Although Medicare covers the physician's TTE services for patients with a number of conditions, Medicare and many private carriers exclude routine or screening TTE from coverage. For example, if you use a screening ICD-9 code, such as V70.0 (Routine general medical examination at a healthcare facility), with 93307, the carrier will likely deny the claim.

But if a physician uses TTE to examine a patient's chamber size or wall thickness, or to evaluate left ventricular function after a myocardial infarction, most payers will cover the service, says Lisa Center, CPC, quality review coordinator for Freeman Health System in Joplin, Mo. Anomalies, Stress Tests Have Different Codes Remember not to confuse 93307 with other TTE codes, such as 93303 (Transthoracic echocardiography for congenital cardiac anomalies; complete) and 93350 (Echocardiography, transthoracic, real-time with image documentation [2D], with or without M-mode recording, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report).

You should report 93303 when the physician performs a complete echocardiography on a pediatric patient to assess septal defects (745.4, Ventricular septal defect; and 745.5, Ostium secundum type atrial septal defect) or other cardiac congenital anomalies, LeFlore says.

If the physician performs a TTE with a cardiovascular stress test in the office, you should assign 93350, Center says. And, you should list the appropriate stress-test code, according to CPT guidelines. Specifically, you should report 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report) to represent the stress test. If cardiovascular stress is induced by pharmacologic means rather than physical exercise, you should also report the appropriate supply code (such as J0152, Injection, adenosine, 30 mg). Append -26 to 93350 You should append modifier -26 (Professional component) to 93350 to indicate that the physician performed the service in the hospital (and that your cardiologist [...]