Inside Angle
From 3M Health Information Systems
Getting to the heart of cardiac coding
Echocardiography is the study of the chambers, valves and major structures of the heart. The CPT books give us specific direction about what to look for within the report to support the complete echocardiography codes.
We coders have a few choices when it comes to selecting the appropriate CPT code for this service. We need to see documentation of the evaluation of the right and left atria, the right and left ventricles, mitral, aortic, pulmonary and tricuspid valves, as well as the pericardium, adjacent portions of the aorta, atrial septum and inferior vena cava, if seen. The sonographer will usually use spectral Doppler and color flow Doppler to aid in the detection of regurgitant valves and to gather information about hemodynamics and intracardiac blood flow. The display will show jets of color leaking through a heart valve and allow the provider to determine the extent of regurgitation or stenosis of a valve and whether the patient will need intervention to improve cardiac function. All of this is coded with a single CPT code, 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.
But what if the provider finds a congenital defect as a result of this study? We have 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete to report an echo for congenital defects, but the CPT book gives little indication about proper usage of this code. There is no age requirement either. There are circumstances where selecting the code is simple, such as “a child with a known cardiac defect has a complete echo.” Yes, 93303, but unlike 93306, this code doesn’t include the spectral Doppler or color flow Doppler, so when used, remember to add 93320 and 93325 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display and Doppler echocardiography color flow velocity mapping. Now, for some not so simple cases.
A patient 30 years status post PDA repair (patent ductus arteriosus, an opening between the aorta and pulmonary artery which is part of normal fetal circulation and routinely closes soon after birth) with no complications but symptoms of new heart disease presents for testing. The defect has been corrected. There is no impact to the patient’s cardiac health as a result of this repair. Is this a congenital study or not? One could argue that through intervention, the patient has returned to normal status. Per CPT Assistant August 2013, if the results of the echo indicate an acquired cardiac condition, report the noncongenital echo code.
An adult patient with no cardiac history, congenital or otherwise presents with a transient ischemic attack (TIA). The study reveals a previously unknown ASD (atrial septal defect). This ASD, whether or not it has impacted the patient’s health, is a congenital defect and this study is now coded 93303, 93320, 93325, assuming appropriate documentation.
An adult patient, status post corrected ToF (Tetralogy of Fallot-four cardiac defects usually including a ventricular septal defect, over-riding aorta, pulmonary infundibular stenosis and right ventricular hypertrophy), with regular yearly follow-up visits with her cardiologist. When this patient has an echocardiogram, it will always be congenital because even though the ToF has been “corrected,” the patient’s cardiac anatomy is still not normal due to the severity of the defect.
Per CPT Assistant May 2015, when an echo is performed on an infant or child with a suspected congenital defect, but none is found, report non-congenital codes. The article goes on to stay that if “simple” congenital anomalies such as PFO (patent foramen ovale) or bicuspid aortic valve are found also use the non-congenital echo codes.
So, when it comes to coding for congenital defects, simple, current, or corrected, we have some guidance from CPT Assistant, but there is still some room for interpretation based on the complexity of the study performed. Happy Coding!
Rebecca Caux-Harry, CPC, is the CodeRyte product specialist for cardiology with 3M Health Information Systems.
2 thoughts on “Getting to the heart of cardiac coding”
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Rebecca Caux-Harry
Product Specialist, Revenue Cycle
Rebecca Caux-Harry, CPC, has worked in the physician coding and billing industry for over 20 years specializing in professional coding compliance. She has served as a clinic liaison to the…
In the above article could you please share where the reference to this is, I can’t find anything to support this.
An adult patient, status post corrected ToF (Tetralogy of Fallot-four cardiac defects usually including a ventricular septal defect, over-riding aorta, pulmonary infundibular stenosis and right ventricular hypertrophy), with regular yearly follow-up visits with her cardiologist. When this patient has an echocardiogram,
“it will always be congenital because even though the ToF has been “corrected,” the patient’s cardiac anatomy is still not normal due to the severity of the defect. “
Thanks for your question. It looks like I didn’t have a specific reference for my comment, but rather an opinion based on the severity of the ToF defect. Correction of Tetralogy of Fallot is a surgical procedure performed very early in the infant’s life and the extent of the correction will depend on the severity of the defect. Follow-up via echocardiogram at regular intervals will be performed because of the original congenital defect and monitoring of the patient’s progress and correction as the infant ages and the heart grows. You can learn more about this defect and correction here. These patients are usually followed throughout their lives to monitor their cardiac function as a result of this congenital defect. Therefore, I believe their echo should be coded as one for congenital anomalies, 93303.