CPT 93306 can be billed for echocardiography/echo. This code covers Doppler and color flow (2-D and M-mode). Reimbursement fees, cost and medical necessity can be found below.
93306 CPT Code Description
CPT 93306 can be reported for echocardiography which is an ultrasonic examination of the heart. It is a popular noninvasive technique for assessing heart anatomy and function. A Doppler examination is a helpful supplement to an echocardiographic examination because it enables for the assessment of the presence and severity of valve stenosis, valvular regurgitation, and ventricular dysfunction of cardiac output, intra-cardiac pressures, and intra-cardiac shunts.
Echocardiography could be complete or limited. Coders who bill CPT 93306 should verify the documentation to confirm complete or limited to avoid any upcoding or downcoding.
CPT 93306 is described as:
- real-time with image documentation (2D);
- includes M-mode recording when performed with spectral Doppler echocardiography and with color flow Doppler echocardiography.
To bill the 93306 CPT as transthoracic echocardiogram the following requirements need to be met:
2-dimensional and (when performed) selected M-mode examination of the:
- left and right ventricles;
- mitral and tricuspid valves;
- the aortic;
- the pericardium and adjacent portions of the aorta; and
- the left and right atria.
A complete echo code is not required in order to assign while M-mode exam is usually performed. The report must indicate the reason because it is impossible to image all of the listed structures
The 93308 CPT code does qualify if a limited transthoracic echocardiogram is done. If the report does not evaluate or attempt to evaluate all of the structures listed above.
CPT Code 93306 vs 93307 vs 93308
When a repeat comprehensive echocardiographic examination is unnecessary owing to a more targeted clinical issue, this is often conducted during a follow-up of a complete echocardiographic examination. CPT code 93308 can be reported as a follow-up study to the 93306 CPT code or the 93307 CPT code, or as a stand-alone code. In some emergent clinical scenarios, a limited echocardiographic study may be performed primarily. It should be noted that all three of these echocardiographic services necessitate image documentation.
Reimbursement & Billing Guidelines
CPT 93306 includes Doppler and color flow (2-D and M-mode). Therefor CPT codes 93320-93325 should not be assigned together with the 93306 CPT code. CPT 93306 excludes transthoracic without spectral and color Doppler. Report the 93307 CPT code for a complete evaluation but without spectral or color flow Doppler and report 93308 CPT code for a follow-up or limited study.
A complete echo is reported with CPT 93306 if no congenital issue is discovered. It is eligible to code echocardiocarghy with modifier 26 (professional component) and Modifier TC (technical component).
Cost Schedule For Reimbursement
Underneath the reimbursement/cost schedule.
|99306||99306 + modifier 26||99306 + modifier TC|
|Non-Fac Pe RVU||4.43||3.91||0.52|
|Facility PE RVU||4.43||3.91||0.52|
Place Of Service
If cardiologist is interpreting for the hospital, the place of service for CPT 93306 is:
- POS 21 (Inpatient Hospital);
- Pos 22 (On Campus-Outpatient Hospital); or
- POS 23 (Emergency Room – Hospital).
Medical Necessity And ICD 10
The ICD-10-CM codes that support medical necessity and provide limited coverage for CPT 93306.
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD 10 CM appropriate to the year in which the service is rendered. Transthoracic Echocardiograph ICD 10 CM supports medical necessity for the 93306 CPT code.
Echocardiography is indicated in the evaluation of derangements of valvular, myocardial and pericardial function. Therefor it is considered medical necessary in the following cases:
- Native Valvular Heart Disease
- Prosthetic Heart Valves (Mechanical and Bio-prostheses)
- Ventricular Function and Cardiomyopathies
- Acute Myocardial Infarction and Coronary Insufficiency
- Hypertensive Cardiovascular Disease
- Cardiac Transplant and Rejection Monitoring
- Exposure to Cardiotoxic Agents (Chemotherapeutic and External)
- Pericardial Disease
- Congenital Heart Disease
- Cardiac Tumors and Masses
- Critically Ill and Trauma Patients
- Suspected Cardiac Thrombi and Embolic Sources
- Contrast echocardiography
- Diseases of Aorta