Cardiology Coding Alert

Question: A pediatrician sent a patient to us because he suspected a congenital heart defect. The cardiologist performed an echo but did not find an anomaly. Should I report a congenital echo code for this service?

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Answer: When the cardiologist performs echocardiography for a suspected congenital anomaly, but does not find one, you should not report a congenital echo code.

Support: CPT Assistant (December 1997) explains that you should not use the congenital echo codes "when a congenital heart disease is suspected, but is not found on echocardiography evaluation. In this case, the noncongenital echocardiography codes should be used."

So instead of 93303-93304 (Transthoracic echocardiography for congenital cardiac anomalies ...) or 93315-93317 (Transesophageal echocardiography for congenital cardiac anomalies ...), you should report a code such as 93306-93308 (Echocardiography, transthoracic ...) or 93312-93314 (Echocardiography, transesophageal ...).

Tip: Don't let clinical significance of the anomaly affect your code. If the cardiologist does find an anomaly, but notes that it doesn't require treatment or that it may heal itself, you still should report the congenital echo code.