In this article, we will compare the differences between CPT Code 93306 vs 93307. We will learn the definitions of these CPT codes, their clinical use, and their application.
In the healthcare industry, medical services are provided to the patients, and insurers are billed for the treatment expenditures. The question is, what is written on the medical bills? Is it a complete description of the medical services provided, or is there any short form mentioned? Medical services are mentioned in the form of CPT codes.
Each medical, diagnostic, or surgical service has some specific code, and these codes are mentioned to ensure the accuracy of the medical bills. In the same manner, echocardiography also has some particular codes, including 93306 and 93307, used while billing for echocardiography services. It is essential for healthcare providers, medical billers, and coders to completely understand these codes for smooth and accurate medical billing and reimbursement.
What are CPT codes?
Current Procedural Terminology (CPT) codes are standardized sets of codes maintained and introduced by the American Medical Association (AMA). Each code is composed of five digits, and these codes are used to describe the clinical, surgical, and diagnostic services provided to the patient. Each code describes the specific medical service, and it is necessary for the generation of accurate medical bills. These codes are used to bill insurance companies and get reimbursements for the medical services they provide.
These codes hold significance for healthcare providers, insurers, and patients, as any wrong-assigned code can cause severe financial damage to any of the parties mentioned above.
Understanding of Echocardiography 93306 CPT code place of service
CPT code 93306 is used for coding a comprehensive transthoracic echocardiogram, which includes real-time imaging, M-mode recordings, and both spectral and color Doppler echocardiography. Echocardiography, commonly known as echo, is a diagnostic test. It is an ultrasound test in which high-pitched sound waves are used to produce images of the heart.
It is totally non-invasive, and the images produced are used to evaluate the condition of the heart. Echocardiography produces an image called an echocardiogram that provides information regarding the heart’s structure, function, structural deformity, and blood flow, helping to make the clinical diagnosis.
Detailed Analysis of 93306 vs 93307
CPT code 93306 refers to a complete transthoracic electrocardiogram using Doppler and color flow imaging techniques. This procedure involves multiple techniques and gives indications about heart conditions.
Components of CPT code 93306
- Transthoracic Electrocardiography: It is a non-invasive procedure in which a transducer is placed on the chest, and heart images are obtained. Detailed information about the heart chambers and valves is extracted from the images.
- Doppler Electrocardiogram: The Doppler technique is used to identify the speed, direction and pattern of blood flow in the heart. It identifies conditions like stenosis and regurgitation of heart valves, which causes the blood flow to be abnormal and turbulent.
- Color Flow Imaging: This technique gives color to the moving elements like blood in the heart. Blood flow direction and pattern are more confirmed using color flow imaging.
Clinical Applications of CPT code 93306
CPT code 93306 is specifically used to diagnose abnormal heart conditions by evaluating the heart structure and function. Common clinical scenarios are the following:
- Assessment of heart failure: The size and pumping function of the heart identified in the echocardiogram help evaluate the heart’s condition.
Valvular Heart Disease: To identify valvular abnormalities like stenosis and ventricular, pulmonary, or aortic valves regurgitation.
Congenital Heart Disease: Tetralogy of Fallot and VSD are identified by 93306 referred echoes.
Cardiomyopathy: To assess the function of heart muscles.
Pulmonary Hypertension: Blood velocity in the pulmonary arteries and right ventricular function is assessed using an echo technique.
Detailed Analysis of CPT Code 93307
If we talk about CPT code 93307 vs 93306, the 93307 code refers to limited transthoracic echocardiography. Doppler and color imaging techniques are not included in this code. The procedure linked with 93307 is less comprehensive than that of CPT code 93306.
Components of CPT code 93307
Transthoracic Electrocardiography: This is a similar component in 93306 vs 93307 codes. A transthoracic electrocardiogram is done in which transducers are placed on the chest wall. Images of the heart are obtained, and the structural and functional assessment of the heart is made. It is less detailed as no Doppler or color imaging techniques were performed.
Clinical Applications of CPT code 93307
When limited evaluation is needed, e.g., during the follow-up, this electrocardiography uses only transthoracic echo. This medical service is mentioned using CPT code 93307 in the medical bills. Following are clinical applications of 93307 code:
- Follow-up Assessment: This code is used when there is a need to perform an echo just for follow-up protocols for the previously identified heart malcondition. There is no need for a deep evaluation of the heart condition.
- Focused Evaluation: When a specific part of the heart is involved, this echo referred to by 93307 is performed. For example, when there is a need to evaluate the mitral valve, pulmonary valve or blood flow only,
- Screening Purpose: This code is used when there is no symptom or sign, and the procedure is only performed for routine screening to assess the heart's function.
CPT Code 93306 vs 93307
Scope Of Examination
While comparing CPT code 93307 vs 93306, both refer to the electrocardiography test for assessing the heart function and structure, but they involve different extents of techniques. For code 93306, a comprehensive evaluation of the heart is done using transthoracic electrocardiography, doppler, and color imaging techniques. While for code 93307, limited evaluation of the heart is done by only using transthoracic electrocardiography. Doppler and color imaging techniques are not done.
Clinical Utility
Code 93306 is used for detailed cardiac assessments to diagnose conditions like heart failure, valvular disease, and congenital heart defects. Code 93307 is used for follow-up, focused evaluation, and screening purposes only.
Reimbursement & Cost
CPT code 93306 has a higher reimbursement rate due to the comprehensive techniques used for cardiac evaluation. Doppler and color flow imaging techniques contribute much more to reimbursement prices. CPT code 93307 has a lower reimbursement rate as it has limited techniques for examination.
Documentation And Billing Guidelines
It is recommended to have proper knowledge of CPT codes 93306 and 93307 and their associated medical services. This helps to generate accurate medical bills. The following components should be documented while billing for these codes:
Proper Documentation
Documentation starts when patients are admitted to the hospital because they are concerned with some specific symptoms of the disease. The reason should be documented when they are asked to get echocardiography performed. Indications for the echo should be noted.
The techniques should be documented, whether transthoracic echocardiography or Doppler and color flow imaging should be performed. Performed medical techniques are noted, and relevant echo codes are granted. After the test, it is essential to mention the findings in the paper, e.g., the state of heart structure and function should be stated.
Interpretations based on clinical findings in the echo by healthcare professionals are also necessary to document. The papers note all the information from indications to the conclusion of echocardiography, and these papers can be used to verify whether any discrepancy arises.
Common Mistakes To Avoid
- Upcoding: Assigning 93306 code for the study that meets the criteria for CPT code 93307 is a prevalent error. It occurs due to human error or fraud to claim for a higher reimbursement rate. This irregularity can pose financial damage to the patients and insurers, and measures should be taken to avoid upcoding in the medical billing process.
- Lack of documentation: Missed information on using Doppler and color flow imaging can lead to uncertainty in assigning the CPT codes. In this case, it is challenging to use code 93306 even if all echo techniques are performed. Therefore, it is necessary to document all services in detail.
- Misinterpretation of codes: Confusing these two CPT codes can lead to incorrect medical billing processes. Lack of ongoing education and hiring less skilled medical billers can be the reasons behind such confusion between the 93306 and 93307 codes.
- Incomplete patient information: Lack of documentation of indications for echocardiography and incomplete patient clinical and personal information can lead to denial or delay in reimbursement for the claims. Therefore, reviewing each piece of information before advancing to the next step is recommended.
Conclusion
Numerous CPT codes exist for different medical services, both clinical and diagnostic. Understanding these codes is essential for accurate medical billing and coding. CPT codes 93306 and 93307 are associated with echocardiography, and each code refers to specific techniques and clinical scenarios. CPT code 93306 is assigned for the echo, including techniques like transthoracic electrocardiography, doppler, and color flow imaging.
This code is clinically applicable when a complete and thorough cardiac evaluation is needed to assess conditions like heart failure, defects, valvular disorders, and pulmonary hypertension. In contrast, CPT code 93307 is applicable only when transthoracic echo is done and when there is a need for limited evaluation, such as in follow-up and focused assessment.
Accurate medical codes should be chosen for smooth and error-free reimbursement. Proper documentation of the indications, techniques used, findings, and interpretation of echo should be performed to avoid mistakes in the medical billing process. We have also covered an important and detailed blog for CPT Codes use in hospital outpatient clinic appointments. So, don’t forget to check that out.
FAQ - People Also Asks
CPT code 93306 describes a complete transthoracic echocardiogram, including real-time imaging, M-mode recording, and spectral and color Doppler echocardiography.
When CPT code 93306 is used with modifier 26, it indicates that only the professional component of the echocardiogram service (interpretation and report) was provided rather than the technical component (the actual test).
The place of service for CPT code 93306 refers to the location where the transthoracic echocardiogram is performed, such as in a hospital, outpatient clinic, or physician’s office.
CPT code 93306 is used for a complete transthoracic echocardiogram, while CPT code 93308 is used for a limited transthoracic echocardiogram, which involves a more focused assessment and fewer components.
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