Medicare changed CPT Code for Echocardiogram and cut reimbursement by 15%
93303 – Transthoracic echocardiography for congenital cardiac anomalies; complete
93304 – Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study – Average fee amount – $130 $150
93306 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography Average fee amount – $210 – $250
93307 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography
93308 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
93320 – Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete
93321 – Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in addition to codes for echocardiographic imaging)
93325 – Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)
93350 – Echocardiography, transthoracic, 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;
93351 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or
93352 – Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)
Echocardiograms
Echocardiography uses high frequency sound waves to record the structure of the heart and blood flow within the heart. Transthoracic echocardiograms (TTE) are the most common type of echo performed. During TTE a transducer is moved on the surface of a patient’s chest to obtain images that are captured for analysis. EKG monitoring is also performed to assist in evaluating the heart in different stages of cardiac cycle. Heart chamber size, contraction, wall motion, wall thickness and valve structure can all be evaluated using echocardiography. Doppler echocardiography is often used to detect acute complications following a myocardial infarction.
Doppler color flow imaging evaluates the blood flow through the heart and displays flow data on 2-D echocardiographic image. Doppler wave form imaging provides directional information about flow, velocity and characteristics. Wave form is obtained when a transducer transmits a series of pulses to detect motion.
Frequently asked question – CPT 93306
CPT code 93306 reimbursement?
Medicare allowable is $204.87
is 93306 a surgical code?
It’s non-invasive study that uses ultrasound to visualize the heart’s function, blood flow, valves, and chambers
is 93306 covered by Medicare?
Yes, covered by Medicare
CPT 93306 requires modifier?
Modifier 26 & TC – Billed when the service is rendered in the hospital setting
No modifier is required when the service is rendered in an office setting
how to bill CPT code 93306?
When all the 3 elements (2D Echo, Doppler, color doppler) are documented.
what is the difference between CPT 93306 and 93307?
CPT 93306 – All 3 elements (2D Echo, Doppler, color doppler)
CPT 93307 – Only 2D and does not include Doppler, color doppler
how often can CPT code 93306 be billed?
The frequency of billing CPT 93306 depends on the diagnosis code from 6 months to annually
To report TTE:
93303–Transthoracic Echocardiography for congenital anomalies; complete
93304 – follow-up or limited study
*Please note codes 93303-93304 are to be used for patients with congenital anomalies only
93306-Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler and color flow Doppler echocardiography (93320 and 93325 are now bundled with this code and should not be reported separately)
93307–Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral Doppler or color flow Doppler echocardiography 93308-follow-up or limited study
+ 93320 – Doppler echocardiography, pulsed wave and/or continuous wave with spectral display. (List separately in addition to codes for echocardiographic imaging) (Use 93320 in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351)
+ 93321 – follow-up or limited study
+ 93325 – Doppler echocardiography color flow velocity mapping
Medicare now has a combined CPT Code for Echocardiograms 93306 to replace the combined codes of 93307, 93320 & 93325. The 93306 reimbursement is 15% less than the combined three codes:
93325 – Doppler echocardiography color flow velocity mapping
e.g. Michigan Region 1:
Billing and Coding Guidelines
What cardiac procedures will require prior authorization?
A Prior authorization is required for the following CPT codes: Diagnostic Catheterization
• CPT codes: 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461 Electrophysiology Implants
• Pacemaker Implant CPT codes: 33206, 33207, 33208, 33212, 33213, 33214, 33227, 33228
• CRT (Cardiac Resynchronization Therapy) CPT device codes: 33221, 33224, 33229, 33231, 33264, CPT Lead 33225
• Defibrillator (AICD) Implant CPT codes: 33230, 33240, 33249, 33262, 33263
Echocardiogram
• CPT codes: 93303, 93304, 93306, 93307, 93308
Aetna Guidelines for coverage
Aetna considers fetal echocardiograms, Doppler and color flow mapping medically necessary for any of the following conditions:
A mother with insulin dependent diabetes mellitus or systemic lupus erythematosus; or
As a screening study in families with a first-degree relative with a history of congenital heart disease; or
Fetal nuchal translucency measurement of 3.5 mm or greater in the first trimester; or
Following an abnormal or incomplete cardiac evaluation on an anatomic scan, 4-chamber study
(Note: When the 4-chambered view is adequate and there are no other indications of a cardiac abnormality, a fetal echocardiogram is not considered medically necessary); or
For ductus arteriosus dependent lesions and/or with other known complex congenital heart disease; or
For pregnancies conceived by in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI); or
In cases of single umbilical artery; or
In cases of suspected or known fetal chromosomal abnormalities; or
In suspected or documented fetal arrhythmia: to define the rhythm and its significance, to identify structural heart disease and cardiac function; or
In members with autoimmune antibodies associated with congenital cardiac anomalies [anti-Ro (SSA)/anti-La (SSB)]; or
In members with familial inherited disorders associated with congenital cardiac abnormalities (e.g., Marfan syndrome); or
In cases with monochorionic twins; or
In cases of multiple gestation and suspicion of twin-twin transfusion syndrome; or
In members with seizure disorders, even if they are not presently taking anti-seizure medication; or
In cases with non-immune fetal hydrops or unexplained severe polyhydramnios; or
When members’ fetuses have been exposed to drugs known to increase the risk of congenital cardiac abnormalities including but not limited to:
Anti-seizure medications; or
Excessive alcohol intake; or
Lithium; or
Paroxetine (Paxil); or
Retinoids; or
When other structural abnormalities are found on ultrasound; or
Aetna considers repeat studies of fetal echocardiograms medically necessary when the initial screening study indicates any of the following:
A ductus arteriosus dependent lesion; or
Structural heart disease with a suggestion of hemodynamic compromise; or
Tachycardia other than sinus tachycardia or heart block.
Hospital Outpatient
Medicare does not separately reimburse for 3D (76376/76377) for hospital outpatients. Rather, the payment is bundled into the base procedure. However, it is important that hospitals continue to establish charges and report these procedures to maintain accurate future rate-setting by Medicare. In addition, the reporting of these services is necessary for maintaining reimbursement with private payers (who may separately reimburse).Note 3D codes are reported in addition to the primary
echocardiography procedure code (e.g., 93306)
Limitations
Echocardiographic studies that are not reasonable and necessary to obtain clinically significant diagnostic or monitoring information are not indicated. The carrier will utilize the American College of Cardiology/American Heart Association (ACC/AHA) Practice Guidelines (Class III) indications as a reference for such determinations.
Coding Information
1. Submission should include an ICD-9-CMcode as listed in the “ICD-9-CM Codes that Support Medical Necessity” and incorporate secondary diagnosis as instructed by ICD-9- CM.
2. Submissions with an ICD-9-CM code other that those in “ICD-9-CM Codes that Support Medical Necessity” will be denied.
3. National Correct Coding Initiative guidelines should be followed.
4. It is medically inappropriate, and contradicts CPT descriptors, to submit CPT 93306, 93307 or 93308, preformed in conjunction with CPT 93350, as 93350 includes a 93306, 93307 or 93308 service.
5. CPT codes 93014, 93041, 93306, 93307 and 93308 should not be submitted on the same date of service. These are inclusive and do not represent independently identifiable services on a common date of service.
6. All diagnosis should be coded to the highest level of specificity.
7. Clinical scenarios deviating from those outlined in “Indications and Limitations of Coverage and/or Medical Necessity” will be denied.
8. Claims with inadequate medical necessity documentation will be denied on review.
9. Examination frequency exceeding those outlined in “Indications and Limitations of Coverage and/or Medical Necessity” when contemporaneous medical records inadequately support medical necessity, will be denied on review.
10. Screening and/or routine interval examinations will be denied.
11. Examinations performed in close proximity to, or alternating with diagnostic testing providing analogous information, e.g., nuclear medicine studies, MRI and CT, will be denied on review. Patterns suggesting parallel or alternating testing will be subject to medical necessity review.
12. Submissions at variance with conditionals enumerated in “Coding Guidelines” and “Documentation Requirements” will be denied on review.
13. Submit services for the contrast material on the same claim or on the same date of service as the echocardiogram.
14. If using Q9955, Q9956, Q9957 or A9700 (supply of injectable contrast material for use in echocardiography, per study) identify the contrast agent in the narrative record of the electronic format. List the name of the contrast imaging agent, route of administration and dosage.
15. I.V. contrast agents are not indicated for all patients undergoing echocardiogram. Overutilization will be monitored.
16. Claims for contrast echocardiography must be supported by documentation that conventional studies were inconclusive and that there was a need for the contrast
enhancement.
17. Stress echocardiography when performed as the only procedure should be reported using 93350 (C8928 for OPPS billing).
18. Effective 01/01/2009, when a stress echocardiography test is performed with continuous electrocardiographic monitoring, physician supervision, interpretation and report by the same physician, then the procedure should be reported using CPT code 93351 (C8930 for OPPS, with or without contrast).
19. Use CPT code 93352 to report the administration of contrast with a stress echocardiogram. (CPT codes 93350 or 93351) for Carrier or Part B claims only.
Old reimbursement
93307 = $192.16;
93320 = $85.40;
93325 = $63.13.
Total: $340.69
New reimbursement:
93306 = $289.69.
This is a cut of $51.00.
Does it Echocardiogram procedure authorisation
Pursuant to the Medicare Advantage Cardiology Prior Authorization Program, the ordering physician/provider or their office staff must obtain Prior Authorization for the following CPT Codes:
Diagnostic Catheterization
• CPT Codes: 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461
Electrophysiology Implants
• Pacemaker Implant CPT Codes: 33206, 33207, 33208, 33212, 33213, 33214, 33227, 33228
• CRT (Cardiac Resynchronization Therapy) CPT Device Codes: 33221, 33224, 33229, 33231, 33264, CPT Lead Code 33225
• Defibrillator (AICD) Implant CPT Codes: 33230, 33240, 33249, 33262, 33263
Echocardiogram
• CPT Codes: 93303, 93304, 93306, 93307, 93308 Stress Echo
• CPT Codes: 93350, 93351
Noncovered
Medicare does not cover echocardiograms performed with equipment that provides limited evaluations. Such evaluations typically do not provide a permanent image and complete interpretation is not performed. These tests have demonstrated value in screening-type evaluations, although they are then considered part of the physician’s exam, similar to a blood-pressure measurement.
Echocardiography performed for screening purposes is not covered. Screening includes testing performed on patients who present with risk factors (including the risk factor as having a positive family history, e.g., familial history of Marfan’s disease). Screening service for high-risk patients is considered good medical practice but is not covered by Medicare. When a screening test is performed, use the appropriate screening ICD-10 code to indicate the test is being done for screening purposes. When the result of the test is abnormal, subsequent services may be billed with the test-result diagnosis; however, the initial screening test must be listed as screening, even though the result of the screening test may be a covered condition. Symptoms or an existing condition must be present to meet medical necessity.
Diagnostic injection services are an integral part of a contrast procedure and are not separately payable.
Q: When performing an echocardiogram for congenital heart defects we use these codes 93303, 93320 and 99325. If the study reveals a normal cardiac structure does the code have to be changed to 93306?
Codes 93303-93304 and 93315-93317 should not be used when congenital heart disease is suspected but not found during echocardiographic evaluation. In such circumstances, the non-congenital echocardiography codes should be reported. (CPT Assistant, August 2013)
Q: Why does the new bundled code 93306 pay much less thna the old code with 93307, 93320 and 93325?
Payment is based on the Relative Value Units (RVU) assigned to the code. The current national Medicare payment for 93306 is $229 physician office, $427 HOPD. The current National Medicare payment for 93307 + 93320 + 93325 is $213 physician office, $427 HOPD.
Q: When performing an echocardiogram for congenital heart defects we use these codes 93303, 93320 and 99325. If the study reveals a normal cardiac structure does the code have to be changed to 93306?
Codes 93303-93304 and 93315-93317 should not be used when congenital heart disease is suspected but not found during echocardiographic evaluation. In such circumstances, the non-congenital echocardiography codes should be reported. (CPT Assistant, August 2013)
Q: I perform a pediatric echo study for a child with a murmur, but is there a way to bill for the congenital study performed as the 93303, 03320 and 93320 code, even if the final diagnosis is only a murmur and on heart defect was detected?
Codes 93303-93304 and 93315-93317 should not be used when congenital heart disease is suspected but not found during echocardiographic evaluation. In such circumstances, the non-congenital echocardiography codes should be reported.
CPT codes 93014, 93041, 93306, 93307 and 93308 should not be submitted on the same date of service. These are inclusive and do not represent independently identifiable services on a common date of service
Q: Can you please speak about reimbursement for 3D Echo, both TEE and TTE. Is there additional reimbursement for it being performed?
Physician
3D codes 76376 and 76377 are paid under the Medicare Part B Physician fee schedule. As such, the services are eligible for payment. Other payers may also separately reimburse.
INDICATIONS AND LIMITATIONS
Spectral Doppler echocardiography and Doppler color flow-velocity mapping (93320, 93321, 93325) may be necessary in addition to an echocardiogram when the examination could contribute significant information to the patient’s condition or treatment plan (For Dates of service on or after 01/01/2009, code 93306 should be used when Doppler is combined with a complete echocardiogram). Typically, Doppler is indicated in the evaluation of some heart murmurs, valvular problems, shunts, suspected congenital heart disease, complications of myocardial infarction, or cardiomyopathy. Doppler should be medically necessary for the evaluation and management of the patient.
“Color/spectral Doppler may not be useful or appropriate in certain relatively small and well-defined patient populations when there is a recent comprehensive examination and the test is being ordered for re-evaluation of a limited problem.” (ASE comment). The use of the Doppler is inherent in the ultrasonic cardiac evaluation. However, if the test reports fail to document the use of this technique to assess these structures and function (e.g., measurement of valvular insufficiency or stenosis, myocardial diastolic function, etc. as described by the ASE), or if the medical records fail to document that the examination was “clinically necessary” (e.g., follow-up of pericardial effusion size) then the Doppler portion of the test may be considered medically unnecessary and denied.
Three-dimensional echocardiography appears to be of clinical value in the pre-operative planning of mitral valve repair for prolapse, and the accurate calculation of mitral valve area. Although it provides improved calculation of volumetric studies when compared to 2D echocardiography, when compared to cardiac MRI, its value in affecting clinical outcomes is not yet proven. When performed in conjunction with transthoracic echocardiography (93303, 93304, 93306, 93307, 93308) it is indicated only for pre-operative planning in those patients in whom surgery is already planned and for monitoring the mitral valve area in patients with moderate to severe mitral stenosis.
93306 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY
Billing for Cardiac Echocardiography Services
Cardiac Echocardiography Without Contrast
Hospitals are instructed to bill for echocardiograms without contrast in accordance with the Procedure code descriptors and guidelines associated with the applicable Level I Procedure code(s) (93303-93350).
Cardiac Echocardiography With Contrast
Hospitals are instructed to bill for echocardiograms with contrast using the applicable HCPCS code(s) included in Table 200.7.2 below. Hospitals should also report the appropriate units of the HCPCS codes for the contrast agents used in the performance of the echocardiograms.
HCPCS Codes For Echocardiograms With Contrast
HCPCS Long Descriptor
C8921
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete
C8922
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study
C8923
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography
C8924
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
C8925
Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report
C8926
Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report
C8927
Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis
C8928
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
C8929
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
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
ICD-10 Codes that Support Medical Necessity
For Procedure codes 93306, 93307, 93308 (with or without Doppler), C8923 and C8924
For Procedure codes 93306, 93307 and 93308 (with or without Doppler)
A18.84 Tuberculosis of heart
A40.0 Sepsis due to streptococcus, group A
A40.1 Sepsis due to streptococcus, group B
A40.3 Sepsis due to Streptococcus pneumoniae
A40.8 Other streptococcal sepsis
A40.9 Streptococcal sepsis, unspecified
A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus
A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus
A41.1 Sepsis due to other specified staphylococcus
A41.2 Sepsis due to unspecified staphylococcus
A41.3 Sepsis due to Hemophilus influenzae
A41.4 Sepsis due to anaerobes
A41.50 Gram-negative sepsis, unspecified
A41.51 Sepsis due to Escherichia coli [E. coli]
A41.52 Sepsis due to Pseudomonas
A41.53 Sepsis due to Serratia
A41.59 Other Gram-negative sepsis
A41.81 Sepsis due to Enterococcus
A41.89 Other specified sepsis
A41.9 Sepsis, unspecified organism
A42.7 Actinomycoti
GENERIC CODES AND NAMES IN NUMERIC ORDER
This list reflects the new classification being used to code drugs reported in NHAMCS. Starting with 2006 data, the Multum Lexicon Plus system was used to classify drugs in NHAMCS. Drugs starting with a “d” prefix are those for which a match was found in the Multum Lexicon Plus®, a proprietary database of Cerner Multum, Inc., and the code reflects the Multum code for the drug. Drugs starting with an “a” prefix are those which were added to the NCHS database in 2006 and 2007 for which a
match could not be found in Multum but for which ingredients could be identified. Drugs starting with a “c” prefix are those drugs added to the NCHS database in 2006 and 2007 for which ingredients could not be determined. Drugs starting with “a” or “c” were assigned codes by NCHS. Starting in 2008, the “a” and “c” codes are no longer being used to code drugs in the NCHS database. Starting in 2008, drugs which were added to the NCHS database for which no match could be found in Multum use an “n” prefix. Ingredients are separated by semi-colons or dashes.
93320 PROTROPIN
93322 RICELYTE
93324 DIDEOXYCYTIDINE
93325 EMLA
93326 INJECTION
93327 ITRACONAZOLE
93330 ASPARAGINASE
93331 VP
93334 CLEMASTINE
93335 APRACLONIDINE
93337 PROPOFOL
93338 DEMECLOCYCLINE
93339 DOAN’S PM EXTRA STRENGTH
Coding Guidelines TEE
1. List the CPT code that describes the procedure performed.
2. List the appropriate ICD-9 code that describes the reason for the test and the patient’s condition.
3. Consult the Correct Coding list for services that are considered included (rebundled) in the procedure code.
4. In the electronic format place the name of the referring/ordering physician in Record FB1-10, 11, 12; and the NPI number of the ordering/referring physician in FB1-13.
5. When the service is performed in a hospital-inpatient/outpatient setting, the technical component is a Part A service, and not billable to Part B.
6. Submit services for the contrast material on the same claim as the echocardiogram, using procedure codes Q9955, Q9956, Q9957 or A9700. In the narrative record of the electronic format list the name of the contrast imaging agent and dosage.
Coding Guidelines: Intraoperative TEE
1. List the CPT code that describes the procedure performed.
2. When CPT codes 93312, 93313, 93314, 93315, 93316, 93317, 93320, *93321, 93325 and/or 93799 are submitted, for intraoperative TEE, by an anesthesiologist (specialty #05), they must be submitted with a “59” Modifier.
3. When one provider inserts the TEE probe, and another provider interprets and reports the findings, the provider who inserts the probe should report CPT code 93313 or 93316, and the provider who interprets the study should report CPT code 93314 or 99317 respectively.
4. In the intraoperative period, CPT 93313 or 93316 can be billed only if a different provider performs and bills 93314-26 or 93317-26, respectively, for the same patient, on the same day of service
5. List the appropriate ICD-9 code that describes the reason for the test and the patient’s condition.
6. When the service is performed in a hospital-inpatient/outpatient setting, the technical component is a Part A service, and not billable to Part B. The physician service should be billed with a “26” Modifier (professional component). This applies to 93312, 93314, 93315, 93317, 93320, *93321, 93325 and 93799.
7. When intra-operative TEE is performed during non-cardiac surgical procedures, by an anesthesiologist, specialty (05), .the medical record must be available to the Contractor upon request. CPT codes for anesthesia during cardiac surgical procedures include 00560 – 00580. 8. CPT code 93318 (echocardiography, transesophageal for monitoring purposes) is not billable during the intraoperative period.
9. When reporting TEE stress test place the following description in item 19 of the 1500 CMS claim form or equivalent field for electronic submission “Transesophageal Stress Echocardiography and Imaging Test, “(CPT 93799). Reasons for Denial
1. Services that do not meet the medical necessity criteria specified under the “Indication and Limitations of Coverage and/or Medical Necessity” sections of the CV-034 policy will be denied as not medically necessary.
2. Routine intraoperative monitoring. (CPT code 93318) will be denied as not medically necessary (Coverage is not allowed for monitoring, or for any other circumstance that does not meet medical necessity for a diagnostic test.)
Billing Guidelines
1. I.V. Contrast Agents:
a. When the initial echocardiogram was sub-optimal due to co-morbidity, report this condition using ICD-9-CM code 794.39.
b. When it is apparent the patient will be difficult to image, due to documented existing co-morbidity, report this condition using ICD-9-CM code 796.4.
2. Diagnostic/Therapeutic infusions and introduction procedures (90760, 90761, 90765, 90766, 90773, 90774, 36000 etc.) are considered integral to a contrast procedure and therefore may not be billed separately.
3. I.V. contrast agents are not indicated for all patients undergoing echocardiogram. Overutilization will be monitored.
OPPS Instructions for Cardiac Echocardiography with Contrast Hospitals are instructed to bill for echocardiograms with contrast using the applicable HCPCS code(s) included in table 14 below. Hospitals should also report the appropriate units of the HCPCS codes for the contrast agents used in the performance of the echocardiograms. Codes in Table 14 should be read as either with contrast studies or without followed by with contrast studies.CPT codes should be used for without contrast studies only. In the without contrast followed by with contrast case, hospitals should not bill the CPT code for a without contrast study in addition to the C-code when they provide a without contrast followed by with contrast study.
Allowable Frequency of Studies and Indications for Use
Many Medicare Carriers provide guidelines on the frequency with which transthoracic echocardiography (TTE) studies will be reimbursed depending on the condition of the patient. Generally speaking, allowable frequencies vary according to the indication for performing the exam and according to the payer to whom the claim is being submitted. Typically, acute symptoms will justify payment. Chronic conditions will fall under frequency guidelines, which vary significantly between payers. Payers do not distinguish between limited and complete exams in assessing the frequency of TTEs. Carriers also vary considerably as to which diagnoses are covered indications for echocardiography services. Check with your local carrier for clinical indications and allowable frequencies of use.
Code Selection
Echocardiography services performed with hand-carried ultrasound systems are reported using the same codes that are submitted for studies performed with cart-based ultrasound systems so long as the usual requirements are met. All echocardiography examinations, regardless of the type of ultrasound equipment that is used, must meet the requirements of requirements of completeness for the code that is chosen and must be documented in the patient’s record.
It is the physician’s responsibility to select the codes that accurately describe the service performed and the correspondingreason for the study. Under the Medicare program, the physician should select the diagnosis or ICD-10 code based upon the test results, with two exceptions.
If the test does not yield a diagnosis or was normal, the physician should use the pre-service signs, symptoms and conditions that prompted the study. If the test is a screening examination ordered in the absence of any signs or symptoms of illness or injury, the physician should select “screening” as the primary reason for the service and record the test results, if any, as additional diagnoses. The following specific coding advice is suggested by SonoSite’s reimbursement staff. (Complete descriptors for codes referenced in the following paragraphs are listed in the attached chart):
• CPT code 93306 – this code represents a complete echocardiogram, including 2D, M-mode recording, when performed, and spectral and color Doppler.
• CPT code 93307 – this code represents the complete 2D study without spectral or color Doppler.
• Do not report “add-on” codes +93320, +93321 or +93325 with either CPT code 93306 or 93307.
• CPT code 93308 represents the limited or follow up 2D echocardiography including M-mode recording when performed.
• To report a color Doppler examination of the flow of blood through the heart’s chambers and valves, report CPT code +93325 in addition to some of the codes for 2D echocardiography. Note that code +93325 is an “add-on” code and cannot be reported separately. It can be used in conjunction with 93308 and 93350, among others.
• To report a quantitative evaluation of flow, CPT codes +9332O and +93321 – pulsed and/or continuous wave Doppler – can be reported for complete studies and limited studies respectively. Limited Doppler, code +93321, is typically used with the Limited 2D code, 93308.
• Note that codes +93320 and +93321 are “add-on codes” and cannot be reported separately. They may be reported in conjunction with 93308 and 93350, among others.
• For stress echocardiography, whether exercise or pharmacologically induced, report CPT code 93350. If color Doppler and spectral Doppler are also performed, those codes may be reported also. However, the components of 93306, 93307 and/or 93308 are included in 93350 Therefore, neither 93307 nor 93308 should be reported in addition to 93350. The appropriate cardiovascular stress test codes should also be reported along with 93350.