In healthcare, medical services are provided to the patients, and insurance companies are billed for the services. Medical bills are not simply generated by mentioning the services provided, as it can cause confusion and errors in the billing process due to the wrong interpretation of information about the medical services.
Therefore, to cope with this issue, Current Procedural Terminology (CPT) codes are assigned for the medical services. It standardizes the medical billing process, and instead of medical services, CPT codes are mentioned on the medical bills. Out of all CPT codes, code 93306 is very important in the field of cardiology. But What is CPT code 93306? This code is assigned for some diagnostic procedures for examining the heart condition.
In this blog, we will discuss the basic concept of CPT code 93306 and its clinical significance. We will also learn the guidelines about the CPT codes.
What is CPT Code 93306?
CPT code 93306 defines transthoracic echocardiography for the evaluation of heart function. This diagnostic test includes imaging, doppler, and color flow evaluation. Echocardiography is a very crucial test, and it is advised in the conditions referring to heart abnormality, either structural or functional. Healthcare practitioners bill the insurance companies for transthoracic echocardiography using the code 93306 in the medical bills.
If we go deep down in the discussion of the CPT code, it is specifically assigned for echocardiography that includes real-time 2D imaging with M-mode recording (if performed), spectral Doppler echocardiography, and color flow Doppler echocardiography.
What are the key components of CPT code 93306?
A CPT code is assigned for transthoracic echocardiography (TTE), which includes three components. In case any component is missing during the procedure, insurers are billed with another CPT code rather than 93306.
1. 2D Imaging
This is the backbone of the TTE diagnostic test, and it provides 2D real-time imaging. Heart function and structure can be visualized with this imaging technique. The size and structure of the heart can be evaluated. The structure of the valves can be examined to check for stenosis, regurgitation, and laxity. The image of surrounding vessels and pericardium also provides insight into the heart evaluation. Diagnosis can be made about the disease.
2. Spectral Doppler echocardiography
Spectral Doppler echocardiography is significant in determining the flow of blood in the heart and major vessels. It gives the indication about the abnormal or turbulent blood flow in many heart disorders like pulmonary or systemic hypertension. Velocity and pressure gradient of blood across valves can also be determined using this technique. Pulse-wave and continuous-wave Doppler are the parts of spectral Doppler echocardiography.
3. Color flow Doppler Echocardiography
This technique in transthoracic echocardiography also measures the blood flow and direction. However, it provides color-coded maps of the blood movement, enhancing the credibility of the evaluation. It is useful in determining the abnormal conditions like stenosis and regurgitation of heart valves.
Clinical Applications of CPT Code 93306
TTE is used as a diagnostic test for different heart anomalies, either congenital or acquired, to confirm the medical diagnosis. It has uses in the following heart disorders:
- Heart Failure: Heart failure occurs when the pumping ability of blood decreases the heart cannot meet the body’s needs. In these conditions, TTE is the first line of diagnostic tools providing information about the condition of heart chambers whether they are hypertrophied or not. The pumping ability of the heart (ejection fraction) is also noted using this technique.
- Valvular Heart Disease: Stenosis (blockage) and regurgitation (leakage) are the two common valvular heart diseases, and they can be assessed easily through Doppler and color flow echocardiography.
- Congenital Heart Defects: Congenital disorders of the heart are the leading causes of death among children if not diagnosed early. TTE helps to detect congenital abnormalities like septal defects, abnormal heart chambers, coarctation of the aorta, and patent large vessels.
- Cardiomyopathy: The heart becomes dilated due to many other underlying causes, and it also causes death in athletes. TTE is necessary as a routine investigation and diagnostic tool in persons with risks for cardiomyopathy.
- Pericardial Effusion: The Pericardium is the sac covering the heart, and in certain conditions like infection and heart failure leads to the accumulation of fluid in the sac called pericardial effusion. Pericardial effusion restricts the pumping function of the heart. TTE can be helpful in the evaluation and diagnosis of pericardial effusion.
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.
Reimbursement and Payer Consideration
CPT code 93306 was reimbursed by the insurance companies and Medicare and Medicaid programs for the echocardiogram investigation. Understanding how each payer reimburses it and what the protocols are in different states is important. Geographical location and specific payer affect CPT code 93306 reimbursement rules. These should be known before submitting a claim for code 93306.
There are some other key factors, like the global period and modifier use, that affect it. CPT code 93306 does not have a global period. It means that players are immersed separately every time an echocardiogram is performed. There is no rule to bill once for all TTC performed on repeat testing in short intervals.
Modifier use should also be mentioned in the medical bills. If all things, including
echocardiograms, reports, and interpretation, are not provided by the healthcare professional, then a specific modifier is used. If only a professional component, i.e., interpretation, is provided, then modifier 26 will be used. Similarly, a TC modifier is used if only the technical component (echocardiogram investigation) is performed.
It should also be noted that CPT code 93306 is a bundled service including 2D imaging, spectral Doppler, and color Doppler. If one component is missing, then another CPT code is used, like code 93307 for 2D imaging only. Read our comprehensive comparison between CPT 93307 and 93306.
Difference between CPT Code 93306 and other Echo Codes
CPT code 93306 for the evaluation of heart functions involves all three techniques used in the transthoracic echocardiogram. If any one component of three is missing, different codes are assigned. Below is the description of all codes related to transthoracic echocardiography, and differences between code 93306 and other echo codes are also mentioned.
Role of CPT Code 93306
1. Continuous Monitoring
Echocardiography helps to evaluate the structural and functional integrity of the heart in chronic heart patients. Chronic heart disorders involve valvular diseases, hypertension, and heart failure. Continuous monitoring through TTE helps to assess disease progression and make management plans.
2. Interdisciplinary Communication
It is important in healthcare to share the information among various organizations and concerned healthcare professionals, including cardiologists, technicians, primary care providers, etc. This assures that all professionals have a clear understanding of a patient’s condition leading to effective decision making regarding the treatment plan.
3. Patient Engagement
It is professional to involve patients in the management plan discussion, and the patient’s choice is always given importance. Echocardiography provides information about the heart’s condition, whether it is improving or deteriorating, and physicians need to discuss everything with the patient. What is the CPT code 93306 role here? Actually, code 93306 stresses the interpretation of results and sharing it with patients, maximizing patient care coordination.
Conclusion
Many CPT codes are assigned for echo investigations to determine the health condition, but code 93306 holds more significance than all other codes. CPT code 93306 defines the diagnostic transthoracic echocardiography investigation to determine the health of the heart. It has three components, i.e., 2D imaging, spectral Doppler, and color flow Doppler.
All these components should be performed to assign the CPT code 93306 to the medical bills. In case of any missing component, other codes like 93307, 93320, and 93350 are assigned. This diagnostic investigation provides information about the heart structure, size, velocity, and direction of blood flow. These parameters help to make the diagnosis and specify the ailment area of the heart. For code 93306, proper documentation from indications for TTE to interpretation of results should be performed for smooth claim submission. There are some payer considerations like global period, modifier use, and bundled service that should be understood clearly.
FAQ - People Also Asks
Coverage depends on the type of insurance company and insurance package. It varies from one package to another. Generally, 10-50% of the echocardiography is covered by the insurers, and the remaining amount is paid out-of-pocket.
Yes, CPT 93306 is applicable for both adult and pediatric patients. However, providers must ensure that echocardiography is appropriate to the clinical indications.
CPT code 93306 can be billed for the same patient one after another if medically necessary and recommended. As it does not have a global period, each echocardiography is billed separately. In the case of repeat echocardiography, insurers can be suspicious and do the scrutiny to prevent fraudulent activity.