Cardiology Coding Alert

... even if of little clinical value

Do the results of a regular echocardiogram show a congenital anomaly? If so, use congenital codes. But if your cardiologist looks for a congenital anomaly and finds nothing, revert back to the normal echo codes.

How a Normal Echo Becomes a Congenital Echo

If your cardiologist does not know that a congenital anomaly exists until he performs the normal echocardiography, you can change your focus to congenital codes 93303, 93304, 93315-93317 as appropriate.

Keep in mind: This rule remains true even if your cardiologist finds a congenital abnormality with little or no clinical significance. You should still report the congenital echocardiography codes.

Example 1: A cardiologist sets out to perform a normal echocardiogram to assess an 89-year-old patient's murmur (785.2, Undiagnosed heart murmur). The echocardiography reveals a tiny muscular VSD (745.4, Ventricular septal defect). Although the cardiologist deems the VSD clinically insignificant, you should still use the congenital echocardiography codes.

Example 2: A cardiologist performs an echo on a patient and discovers a patent foramen ovale (PFO) that does not warrant any treatment. In this case, you would still use the congenital echo codes (93303, 93304, 93315-93317). "Even though the PFO is likely to close, it's still a congenital heart defect and therefore a congenital echocardiogram exam," says Elizabeth Crawford, technical director of the echo lab, Children's Hospital, Boston.

No Evidence of Congenital Heart Disease, Then Normal Echo

When a patient undergoes an echocardiogram and the results do not point to congenital heart disease, you should not report the congenital echocardiography codes. You will not have justification.

For example: If your cardiologist suspects congenital heart disease because a physician detected a heart murmur in a newborn baby or the patient's family history suggests that a congenital anomaly might be present, he might order a congenital echocardiogram.

If the results do not reveal anything congenital, you must report the normal echo codes (93307, 93308, 93312-93314).

"You have all the appropriate clinical indications for performing the echo. It's just that you didn't find anything that was a congenital condition," says Sheldrian LeFlore, CPC, senior consultant with Gates, Moore & Company in Atlanta.

"If we find nothing, we find nothing," Crawford says. "Even if the patient has a full exam but does not have anything congenital - like our heart transplant patients - they are not congenital exams; we know they don't have congenital heart disease."

So you would report the normal echo codes (93307, 93308, 93312-93314).