Echocardiography is among the most commonly performed cardiology services. Coding these diagnostic tests, however, can be anything but routine. There are several variations on the basic echocardiogram, each with its own particular documentation requirements. In addition, non-physician practitioners often perform the tests, and medical necessity and diagnosis code requirements vary.
As a result, cardiologists need to document exactly what they did in the operative report, and their coders need to read all of the documentation in the operative report and familiarize themselves with their carriers medical necessity and diagnosis guidelines to determine when a particular service (or combination of services) is payable.
CPT 2000 lists 14 echocardiography codes describing the following distinct procedures:
basic transthoracic echocardiogram (TTE)
Doppler echo and color flow mapping
stress echo
transesophageal echo (TEE)
contrast echo
Note: There also are separate codes for echos involving patients with congenital heart disease.
How to Code Basic Echocardiograms (TTE)
A transthoracic echocardiogram (TTE), commonly referred to as an echo, is a non-invasive study that visualizes the hearts function, blood flow, valves and chambers. Echos use ultrasound technology similar to that used to observe a fetus in the womb. The ultrasound produces real-time images that are recorded on videotape and interpreted by a technician or physician.
The following two codes describe the basic, transthoracic echo:
93307 echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording; complete; and
93308 follow-up or limited study.
There is no code for only the professional component of the basic echo, so if the cardiologist doesnt own the equipment, the complete echo cannot be billed. Instead, modifier -26 (professional component) must be attached to either 93307 or 93308.
If the cardiologist also performs an examination, both services are billable. Modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should not be attached to the appropriate evaluation and management
(E/M) code because the echocardiogram is a diagnostic test and is found in the Medicine section of the CPT manual, says Stacey Elliott, CPC, manager of contracts, compliance and information systems, with COR Associates, an 11-physician group in Los Angeles.
If the echocardiogram yields a more specific diagnosis, that diagnosis code should be associated with the test code, whereas the pretest diagnosis code should be linked to the E/M service code, Elliott says. She notes, however, that a single diagnosis is sufficient to obtain payment for both the E/M and the echo.
If a nurse or technician performs the echocardiogram under the incident-to guidelines, the physician must be present and immediately available, says Quin Buechner, MS, MDiv, CPC, a non-physician practitioner (NPP) coding and reimbursement specialist in Cumberland, Wis. [...]
