Cardiology Coding Alert

Question: Could you help me understand the rules for reporting codes TTE codes 93303 and 93304?

Colorado Subscriber

Answer: Codes 93303 (Transthoracic echocardiography for congenital cardiac anomalies; complete) and 93304 (…follow-up or limited study) both describe transthoracic echocardiography (TTE) for congenital anomalies. Cardiologists use TTE on children and young adults to obtain accurate anatomic definition of most congenital heart diseases. TTE can sometimes prevent the need for preoperative catheterization.

Code 93303: When the cardiologist provides a 93303 service, he performs a complete TTE to obtain images of the heart structures through the chest wall in patients born with heart defects. A 93303 service includes visualization of heart chambers, valves, blood flow, and cardiac activity.

Code 93304: You would report 93304 for a follow-up or limited TTE study for congenital cardiac anomalies.

Caution: “Codes 93303 and 93304 should not be used when complex congenital heart disease is suspected but not found on echocardiographic evaluation or for ‘simple’ congenital anomalies such as patent foramen ovale (PFO) or bicuspid aortic valve,” according to CPT^® Assistant Vol. 25, No. 5. “In these cases, the non-congenital echocardiography codes (93306-93308) should be used.”

Rule of thumb: Report congenital echoes on known and suspected confirmed complex congenital heart anomalies, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. The cardiologist’s order will assist with intention of the diagnostic echo procedure. Congenital heart anomalies inadvertently identified during an echo are initially reported with a non-congenital echo code (93306-93308).

Reminder: Review codes C8921 (Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete)-C8930 (Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision) when contrast or without contrast followed by contrast is performed on a Medicare patient or a payer who follows Medicare’s guidelines.