Medical billing and coding are crucial processes in the healthcare sector. Descriptions of medical bills are not directly written on them. Codes are mentioned on the bills, and each code defines a specific treatment or medical service. Incorporating Current Procedural Terminology (CPT) codes in medical bills has made the billing process more effective and error-free. CPT code 93307 is assigned for transthoracic echocardiography to evaluate the heart condition and its functioning.
A complete understanding of the 93307 code is essential for both clinicians and medical billers to record everything correctly while documenting. In this article, we will learn the clinical indications and technical details of 93307. We will also discuss other guidelines about the CPT code, i.e., its usage, clinical significance, and how it helps to improve the health of patients.
What is CPT Code 93307?
Code 93307 refers to the transthoracic echocardiogram without spectral and color flow Doppler. Only a 2D heart image is obtained using ultrasound waves in this code.
Heart images help healthcare providers assess the heart’s condition and make a management plan accordingly. 2D images are used to assess the anatomical structure of the heart and large vessels. It is impossible to determine the velocity and direction of blood flow.
Transthoracic echocardiography is a diagnostic procedure that detects heart anomalies. It is totally non-invasive, and images are obtained by placing a transducer on the chest.
When is the Echocardiogram CPT Code 93307 used?
CPT Code 93307 is used in the primary assessment of heart conditions. Heart structure, i.e., heart valves, heart chambers, surrounding vessels, and pericardium, is assessed to detect the root problem of the heart. There are a few indications that make it compulsory to get the echocardiogram:
- Suspected Heart Valve Disease: Abnormal sounds like murmur and blood clicks are heard on a stethoscope, which leads to suspected valve problems. For a clear diagnosis, echocardiography is necessary.
- Chest Pain Or Discomfort: Chest pain on the left side is an indication of heart problems. An echocardiogram is the first line of investigation for making a diagnosis and management plan.
- Shortness Of Breath: Lung diseases and some serious heart problems like heart failure and pulmonary hypertension can lead to breathing problems. To rule out heart conditions, it is necessary to get an echocardiogram.
- History Of Congenital Heart Disease: Some children are born with congenital heart problems, and it is recommended to get their echocardiogram periodically in order to avoid sudden heart failure.
- Abnormal ECG Results: An irregular or abnormal electrocardiogram (ECG) indicates for further investigations to detect the problem. That's why echocardiography is recommended in this case.
1. 2D Imaging
Procedural detail for CPT Code 93307
The echocardiogram for code 93307 is non-invasive, and it does not require many protocols like fasting or anything else. Typically, it takes 30-60 minutes to perform TTE. The patient is asked to lie on the left side for better access to heart structures, and gel is applied to the chest to avoid friction when the transducer is placed.
This procedure is similar to ultrasound, as a chest transducer is placed through which ultrasound waves are emitted. Waves penetrate deep and bounce back from the heart structures. The bounced waves are converted into an image, and an echocardiogram is obtained. Real-time assessment is also possible, as cardiologists can view the changing heart structure each time waves bounce back. Heart functioning and other parameters can be detected in this way.
The final step is the interpretation of the findings and making a final report. After getting the echocardiograms of the heart, the cardiologist makes a diagnosis and records it. Management plans are made and shared with the patient and other related staff members. Heart valves are examined to determine whether they are normal or stenosed.
If heart chambers are hypertrophied, then it can cause pulmonary hypertension, leading to serious outcomes. Echocardiogram code 93307 also helps to detect the fluid build-up, if any, in the pericardium. These things are examined by the cardiologist in the echocardiograms to provide the best possible treatment.
How documentation and coding for CPT 93306 should be done?
Proper documentation is the key to successful claim submission and reimbursement approval. The medical records must possess all the necessary information, from the indications for the echocardiogram to the end interpretation of the echo report.
Clear indication, report findings, and interpretation of results are the three main steps that should be followed during this whole process. Before the TTE, clear indications such as heart failure, chest pain, edema, and other causes should be documented. Then, the patient is advised to get these tests done. A report is made for the investigation. To comply with the CPT code 93306, all three components, 2D imaging, doppler, and color flow, should be done.
After the result report, it is the duty of healthcare professionals to make an interpretation of the findings. Everything should be documented for smooth and objection-free claim submission. Medications, referrals, and management plans should be made and documented by the healthcare professional.
Difference Between CPT Code 93307 and Other echocardiogram codes
There are many other codes which are also concerned with transthoracic echocardiography. There are only a few differences in the description of each code. CPT Code 93307 description, along with other codes, are mentioned in the table below. You should also read our thorough comparison between 93306 & 93307.
Billing and reimbursement for CPT Code 93307
Billing and reimbursement requirements should be kept in mind while billing for CPT Code 93307, as a small error can lead to claim denial. Appropriate and effective billing is required for the financial stability of healthcare organizations. There are a few guidelines about CPT Code 93307, which are mentioned below:
- Medicare protocols should be followed to get reimbursement for the performed echocardiography. The Medicare program does not bill for the service until it is properly documented. It is also recommended that Medicare follow its Local Coverage Determinations (LCDs), which provide information on which procedure is covered under the Medicare program.
- As echocardiography is an expensive service, private insurers require pre-authorization. Generally, all private insurance companies cover echocardiography for code 93307, but it is essential to check your package first.
- In the case of multiple echocardiography investigations, each is billed separately, and insurance companies also do the audit if they suspect unnecessary TTE is being done.
- Modifier 26 is used for professional components only, and the TC modifier is used only if technical components are involved.
Professional vs. Technical Component
The professional component refers to the services provided by the cardiologist in terms of the interpretation of findings and making a final report. Modifier 26 is used in the medical bills if only a professional component is performed. It is done when a patient gets the echocardiography from another hospital setting and comes to the cardiologist for interpretation of findings. It is essential to mention it in the medical bills to comply with rules and regulations.
Technical components denote the operational process done by a technician to perform the echocardiography. Equipment used and service of technologists is covered under technical components. Modifier TC is used in this scenario, and insurers are billed as CPT Code 93307-TC in the medical bills.
There is another scenario known as global billing in which both professional and technical components are billed together without using any modifier. This is achieved when both services are provided by healthcare professionals in the same clinical setting.
Conclusion
93307 CPT code definition refers to the transthoracic echocardiography with only one component involved. Only imaging is done using ultrasound waves to get the heart images, which are termed echocardiograms. Cardiologists detect heart anomalies by evaluating the images, or they can also do real-time observation at the time of echocardiography. Heart structure is mainly assessed using this technique.
Heart valves, pericardium, large vessels, and heart chambers are observed for any abnormality. Starting from indications of echocardiography to interpretation of findings, everything comes under the CPT Code 93307. All information should be documented step-wise, as insurance companies ask for these details before reimbursing for echocardiography. The procedure is simple and easy and involves lying the patient on the left side, lubricating the chest, placing a transducer, and obtaining the final images of the heart. Modifiers should be used if one component is used from professional and technical components. Other echocardiography codes should also be kept in mind to avoid billing mistakes.
FAQ - People Also Asks
Ninety-three thousand three hundred seven can be billed for many times depending on the medical necessity and payer’s guidelines. Medicare and insurance companies generally cover code 93307, but they need documented indications for the test performed. In case of ongoing treatment, follow-up plans, and monitoring heart conditions for post-operative evaluation, 93307 can be billed again and again for sure.
Yes, some parties require prior authorization. Private insurers ask for this protocol to be followed to get the reimbursement rate. On the other side, the medicare program does not ask for prior authorization; it just needs a medical necessity document for echocardiography.
CPT Code 93307 can be billed with other cardiac tests under certain rules. It can be billed with other diagnostic tests like stress level tests required in cardiological problems. However, it cannot be billed with investigations like spectral and color flow Doppler.