Cardiology Coding Alert

Question: Our physician's echocardiographic report lists measurements for a typical two-dimensional study, such as aortic root dimension, IV septum thickness, and cardiac chamber measurements. The documentation for the study follows.
 
Two-dimensional (2-D) image and Doppler interpretation results:

1. There is mild left atrial dilatation. There is moderate left ventricular hypertrophy. The left ventricular systolic function is normal without focal wall motion abnormalities. Estimated ejection fraction is greater than 60 percent.

2. Mitral valve demonstrates annular calcification. There is trivial mitral insufficiency. Mitral inflow is unremarkable. There is no systolic anterior motion noted of the mitral valve apparatus.

3. The aortic valve is moderately thickened and calcified. The peak velocity across the aortic outflow is 4.3 m/sec for a peak gradient of 73 and a mean gradient of 45 mmHg. The calculated aortic valve area is 0.7 sq cm consistent with severe aortic stenosis. There is mild aortic insufficiency seen with a pressure half time of 650 msec.

4. The tricuspid valve is structurally normal. There is mild tricuspid insufficiency seen. Normal pulmonary pressures.

5. There is no mass, thrombus or effusion identified. 

Conclusions: 

1. Asymmetric septal hypertrophy with preserved left ventricular systolic function.

2. Severe aortic stenosis with mild aortic insufficiency.

Based on these results, should I bill 93307, 93320 and 93325?

Texas Subscriber

Answer: The correct codes for this study are 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete) and +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete).       
 
Many coders have the habit of also billing 93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]) for color flow with echo studies. In your echo report, however, there is nothing that definitively establishes that the physician performed a color flow study. 

Indeed, color flow imaging is a specialized Doppler study that electronically paints blood different colors, depending on the direction the blood is flowing. This form of imaging helps to evaluate the degree of valvular regurgitation (also known as valvular insufficiency), which occurs when the blood flows in the wrong direction across one of the heart's valves. 

Because color flow is a separately billable and separately reimbursed service, the physician must definitively document this service in the report before you can bill it. The documentation challenge faced by physicians is that valvular regurgitation is also evaluated by the pulsed wave Doppler study (93320.) 

If a report states that the Doppler study reveals moderate mitral regurgitation, an auditor may give credit for the Doppler but not the color flow study. To be safe, the report should specifically contain findings of the color flow study. Most physicians agree that full evaluation of valvular function requires a color flow study. Many do not specifically mention the findings of the color flow in their reports, so you should encourage your physicians to note this clearly.