Cardiology Coding Alert

You stand a better chance of receiving full reimbursement for continuous/pulsed wave Doppler with spectral display and Doppler color flow velocity mapping if you demonstrate medical necessity for these codes, which are used in addition to codes for echocardiography, 93307-93308 and 93312-93314.

The supporting documentation in the physician's report should clearly reflect the need for these modalities, in addition to the basic echo, says Denise White, CPC, a cardiology coding consultant with Acevedo Consulting of Delray Beach, Fla.

Physicians should make sure they specifically document in their reports that they used Doppler spectral display and/or color flow mapping, why they used these additional tests, and the test results, says Savanna Siens, CPC, CCS-P, a cardiology coder with Northland Cardiology in Kansas City, Mo.

Moreover, the report should include key terms from the CPT descriptions of Doppler echocardiography studies (+93320, +93321 and +93325) to justify coding these add-on codes, says Cynthia Swanson, RN, CPC, a coding consultant with Seim, Johnson, Sestak and Quist in Omaha, Neb.

Siens says cardiologists in her practice have revised their dictation templates to ensure they're providing the information payers require for Doppler reimbursement. In addition to general information about the patient, physicians indicate which Doppler study they ordered, the reason or indication for the Doppler study, and the results, she notes.

Coders also need to know where the cardiologist performed the Doppler service (hospital, outpatient center, physician's office), who performed what components of the service, who is entitled to bill the technical component or if services should be globally billed, the type(s) of echocardio-graphy testing performed (93303-93350) and if any add-on codes (93320, 93321 and 93325) apply, Swanson says.

In addition, if another physician refers a patient to a cardiologist for a Doppler, the referral letter must specifically indicate that the physician ordered the Doppler, says Sheldrian Wayne, CPC, a cardiology coding specialist with Atlanta-based Coding Strategies Inc. Although medical necessity may support the performance of a Doppler echo, the referring physician should approve the additional services, she says.

Since late 1998, CMS has not covered claims for Doppler echocardiography if the primary-care physician (PCP) who referred the patient to the cardiologist does not explicitly mention the word "Doppler" in the referral. Medicare auditors are scrutinizing such claims, and if a specific reference to a Doppler test is not there, the Medicare carrier may demand a refund.

Therefore, cardiology practices should monitor referrals and instruct PCPs to resubmit referrals that inadvertently omit specific references to Dopplers. In most cases, the PCP intends for the patient to receive thorough diagnostic testing, which includes a Doppler echo, coding specialists say.