Coding Corner

Documentation and Coding for Echocardiography

George A. Sample, MD*
Senior Attending, Critical Care
Washington Hospital Center
Washington, DC, USA

Val Veitengruber, CPC, CMSCS, CHCO**
Reimbursement Manager
SonoSite, Inc.
Bothell, Washington, USA

As the use of bedside or point-of-care ultrasound in intensive care units (ICUs) increases, it is important to employ accurate documentation and coding of these services. This Coding Corner addresses information specific to echocardiography and the physician’s professional services.

The number of physicians billing Medicare for transthoracic echocardiography is relatively small, as exemplified in Table 1. What should be noted, however, is that the billings are increasing significantly. These numbers reflect not only the portability and availability of the technology, but also its clinical usefulness.

In general, Medicare Part B will reimburse physicians for medically necessary diagnostic ultrasound services, provided the services are within the scope of the physician’s license.

A limited number of Medicare carriers require that physicians performing and/ or interpreting echocardiography studies attain Level II competency, as defined by the American Heart Association (AHA) and the American College of Cardiology (ACC). Others require that the provider who performs the interpretation possess the knowledge, skills, training and experience minimally necessary for this component of the service. This determination is based on accepted community standards.

The documentation requirements of echocardiography include both a written report and permanently recorded image(s). A final written interpretation of all echocardiography studies must be kept in the patient’s record, as well as the rationale for performing the studies. In addition, echocardiography codes require the production and retention of image documentation. Permanent images, either electronic or hard copy format, must be retained in the patient’s record or another archive to meet the requirements of billing of the Current Procedural Terminology (CPT®) codes.

The selection of CPT codes is determined by the approach and type of the echocardiography examination. The transthoracic (TTE) and transesophageal (TEE) approaches each use a distinct set of codes. The TTE codes are further distinguished by complete versus follow-up or limited studies.

TTE Complete Studies

• Use CPT code 93306 for dates of service on or after January 1, 2009, this code represents a complete echocardiogram, including 2D, M-mode recording (when performed), and spectral and color Doppler.

• Use CPT code 93307 for dates of service on or after January 1, 2009, 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.

TTE Follow-up or Limited Studies

• CPT code 93308 represents the limited or follow-up 2D echocardiography, including M-mode recording, when performed.

• Report add-on code +93321 when quantitative evaluation of flow-pulsed and/or continuous-wave Doppler is performed with the limited 2D examination.

• Report a color Doppler examination of blood flow through the heart’s chambers and valves using CPT code +93325 in addition to 93308 for the limited 2D echocardiography.

Note that +93321 and +93325 are “add-on codes” and cannot be reported separately. They may be reported in conjunction with 93308 when both spectral and color Doppler are performed.

TEE CPT Codes

Codes for TEE services are broken out differently, using separate coding in specific circumstances.

When one physician provides the entire service:
• CPT code 93312 describes the entire TEE service – echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording), including probe placement, image acquisition, interpretation and a report.

In instances in which the service is provided by two physicians:|
• Use CPT code 93313 for echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only.

• Use CPT code 93314 for echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only.

Thus, CPT code 93313 is reported by the physician who only places the TEE probe; the other physician codes 93314 to report the remaining elements of the service. CPT codes 93312 and 93314 require image documentation and a written interpretation to satisfy the billing requirements.

As with the limited TTE, CPT code 93308 and the add-on codes +93321 and +93325 are also reported separately when spectral and color flow Doppler are performed with either CPT code 93312 or 93314.

Physician billing for all of these CPT codes (with the exception of 93314, which has only the professional component) is submitted with the -26 modifier appended (i.e., 93308-93326) to indicate the professional component. The hospital is responsible for submitting the facility charges with the appropriate ICD-9-CM codes.

George Sample, MD, from Washington Hospital Center in Washington, D.C., is the special guest editor for Coding Corner.

Above coding text reprinted with permission from SonoSite, Inc.

References:

1.  Current Procedural Terminology (CPT). American Medical Association Web site. Accessed January 27, 2010.


Disclosures:

*Author has no disclosures to report

**Author is an employee of SonoSite as a coding and reimbursement expert