Basics of CPT code 93306/93307 Echocardiography/Electrocardiography

There are different CPT codes for Echocardiography in medical coding. They are mainly divided into transthoracic and transesophageal echocardiogram. If you are new to coding echocardiography, this article will be very helpful for gaining knowledge about CPT code for echocardiography/electrocardiography (ECG or EKG). Procedure or CPT code 93303, 93304, 93306, 93307 and 93308 are used for coding 2d echocardiogram.

We will discuss the techniques and the full code description of all the echocardiogram CPT codes. Also, you will be able to understand the difference between these procedures codes and when to use them while coding medical charts. So, let us learn more about them.

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CPT code for Transthoracic Echocardiography

The technique to visualize a heart’s function, blood flow, valves and chambers using ultrasound is called as echocardiography. There are different CPT codes for Echocardiography depending on the approach, with or without Doppler and with or without stress. So, first we will checkout the transthoracic echocardiogram procedure codes.

93303 Transthoracic echocardiography for congenital cardiac anomalies; complete

93304  follow-up or limited study

A complete Echocardiography study examines the left and right atria, left and right ventricles, aortic, mitral, tricuspid valves, the pericardium, and adjacent aorta sections. This evaluation requires multiple views for a comprehensive functional and anatomic assessment with appropriate measurements recorded.

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When to use CPT code 93306, 93307 and 93308 for ECG/EKG electrocardiography/echocardiography

For two-dimensional echocardiogram or real-time imaging, multiple transducers are used and images are recorded using a video recorder. M-mode, when used gives more accurate information on the specific region of the heart.  CPT code 93306, 93307 and 93308 are used for coding transthoracic echocardiography with M-mode recording with or without spectral or color Doppler echocardiography. Below is the detail code description for each 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

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

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When to use ECG or EKG CPT code 93350 and 93351

For some procedure the echocardiogram images are recorded before and after stress and sometimes during stress. The stress exam includes walking on treadmill, using a bicycle or administration of pharmacological agent to stimulate exercise. The patient heart rate, blood pressure and ECG are monitored throughout this procedure. CPT codes 93350 and 93351 are the major CPT codes using for coding stress echocardiogram.  Use CPT code 93350 when the complete cardiovascular stress test including the ECG monitoring, supervision, interpretation and report by a physician or qualified healthcare professional. When only the professional component of a complete stress echocardiography is provided by same physician, use CPT code 93551 with modifier 26.

 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– including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional

+93352 – Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)

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CPT codes for Transesophageal Ecocardiography (TEE)

In this technique, the transducer is placed at the tip of the endoscope and then introduced into the patient’s esophagus to record the 2-Dimension echocardiogram. These technique is very helpful for detecting the cardiac emboli, prosthetic heart valve malfunction, endocarditis, aortic dissection, cardiac tumor and valvular heart disease. There are multiple CPT codes for transesophageal echocardiography which are described below.

93312 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report

93313 placement of transesophageal probe only

93314 image acquisition, interpretation and report only

93315 Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report

93316 placement of transesophageal probe only

93317 image acquisition, interpretation and report only

93318 Echocardiography, transesophageal (TEE) 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

+93319 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging) (added in 2022)

93355 – Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg,TAVR, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intra-procedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D

Hope, you would have now able to differentiate between different CPT code for echocardiography (Transthoracic and Transesophageal) and will use them correctly in future. Do share the article if you liked it and share your thoughts in the comment section.

Supply and Equipment codes used with CPT code 93306 and 93307

SA048 pack, minimum multi-specialty visit
SB006 drape, non-sterile, sheet 40in x 60in
SD053 electrode, ECG (single)
SJ062 ultrasound transmission gel
SM022 sanitizing cloth-wipe (surface, instruments, equipment)

ED050 Technologist PACS workstation
EL015 room, ultrasound, general

Supply and Equipment codes used with CPT code 93312 and 93313

SC014 Interlink adaptor
SC015 Interlink vial access
SC029 needle, 18-27g
SC051 syringe 10-12ml
SD006 bite block
SD127 tube, suction NG (Salem sump)
SH030 Emla cream
SH040 heparin lock flush soln
SH047 lidocaine 1%-2% inj (Xylocaine)
SH068 sodium chloride 0.9% inj bacteriostatic (30ml uou)
SJ043 povidone swabsticks (3 pack uou)
SJ061 tongue depressor
SJ062 ultrasound transmission gel
SK059 paper, recording (per sheet)
SK062 patient education booklet
SM018 glutaraldehyde 3.4% (Cidex, Maxicide, Wavicide)
SA048 pack, minimum multi-specialty visit
SB006 drape, non-sterile, sheet 40in x 60in
SB033 mask, surgical
SB044 underpad 2ft x 3ft (Chux)
SC003 arm board

ED050 Technologist PACS workstation
EL016 room, ultrasound, vascular

Below are the RVUs for these procedures

93307- 0.92

93308 – 0.53

93306 – 1.5

93350 – 1.46

93351 – 1.75

+93352 – 0.19

93312 – 2.3

93313 – 0.26

93314 – 1.85

93316 – 0.6

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Do and Don’t ECG or EKG (electrocardiography/Echocardiogram) CPT code

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.

Use 93319 in conjunction with 93303, 93304, 93312, 93314, 93315, 93317

Do not report 93319 in conjunction with 76376, 76377, 93325, 93355

List of HCPCS codes used for Echocardiography with contrast

C8921 TTE with contrast for congenital cardiac anomalies; complete

C8922 TTE with contrast for congenital cardiac anomalies; follow-up or limited study

C8923 TTE with contrast, (2D) with or without m-mode recording; complete

C8924 TTE with contrast, or without contrast followed by with contrast, (2D) with or without m-mode recording; follow-up or limited study

C8925 TEE with contrast, or without contrast followed by with contrast, (2D) (with or without m-mode recording); including probe placement, image acquisition, interp and report

C8926 TEE with or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interp and report

C8927 TEE with contrast or without contrast followed by with contrast, for monitoring purposes, including probe placement, 2-D image acquisition and interp leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis

C8928 TTE with contrast, or without contrast followed by with contrast, (2D), with or without m- mode recording, during rest and CV stress test using treadmill, bicycle exercise and/or  pharmacologically induced stress, with interp/report

C8929  TTE with contrast, or without contrast followed by with contrast, (2D), includes m-mode  recording, when performed, complete, with spectral Doppler echocardiography, and  with color flow Doppler echocardiography

C8930  TTE, with contrast, or without contrast followed by with contrast, (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill,  bicycle exercise and/or pharmacologically induced stress, with interp/report; including performance of continuous electrocardiographic monitoring, with physician supervision

NCCI edits for CPT code 93303, 93304, 93306, 93307 and 93308

References:

http://www.umiultrasound.com/cardiology-cpt-codes