In the dynamic realm of cardiac imaging, every tool plays a vital role in unraveling the complexities of the heart. For cardiologists, echocardiography is an integral procedure. It offers invaluable insights into the structure and function of the heart.
However, when the nuances of blood flow demand deeper scrutiny, advanced techniques come into play. Add-on codes like CPT code 93325 often represent these techniques.
Therefore, you should also master the application and billing of these add-on codes to streamline reimbursement collection for the echocardiography procedure.
This guide will cover everything related to CPT 93325. Without further ado, let’s get started so you can harness its full potential in your clinical practice.
CPT Code 93325 – Description
CPT code 93325 is an add-on code from the ‘Echocardiography Procedures’ code range and is maintained by the American Medical Association (AMA). It covers Doppler echocardiography.
It is a diagnostic procedure that involves the Doppler sound effect and color flow velocity. It visualizes a two-dimensional (2D) image representation of blood flow in the heart that shows the velocity and direction of blood flow in different colors.
For the unversed, cardiologists employ this technique during an echocardiogram to gather additional information about the blood flow. Typically, cardiologists order this procedure after obtaining images from primary echo codes, such as 93306, 93308, etc., onto which the color flow is mapped.
Scenarios Where CPT Code 93325 is Applicable
Let’s review some clinical scenarios to understand where the CPT 93325 applies:
Valvular Regurgitation Evaluation
Picture this: A 65-year-old male patient with a history of mitral valve prolapse visits the cardiologist. He complains of persistent fatigue and shortness of breath that is also increasing in intensity.
As a result, the cardiologist orders a comprehensive transthoracic echocardiogram (TTE), CPT 93308, and color flow Doppler (CPT code 93325).
The TTE visualizes the structure and function of heart chambers and valves, including the mitral valve. Contrarily, the latter procedure’s color mapping helps the cardiologist assess the extent and direction of the regurgitant jet. Moreover, the Doppler velocities quantify its severity.
Congenital Heart Defect Assessment
Consider this: A guardian brings in a 6-month-old infant for a routine check-up. However, during the visit, the pediatrician suspects a congenital heart defect due to a heart murmur. The pediatrician refers the infant to a cardiologist.
Therefore, the cardiologist orders a congenital echocardiogram (CPT 93303) and color flow Doppler (CPT code 93325). CPT 93303 offers detailed 2D and potential M-mode images of the infant’s heart anatomy, including the atrial septum. On the other hand, CPT 93325 visualizes blood flow between the atria across the septal defect.
Both procedures are medically necessary because the comprehensive congenital echocardiography provides the anatomical information, and color flow Doppler adds the crucial hemodynamic assessment of the shunt.
Structural and Hemodynamic Evaluation
Imagine this: A 50-year-old male patient visits the clinic with a new onset of a heart murmur. The cardiologist requests a complete transthoracic echocardiogram (CPT 93306) and the color flow Doppler (CPT code 93325).
The CPT 93306 visualizes two-dimensional images of all four heart chambers, valves, and the aorta. These images help the cardiologist assess blood flow velocity through the aortic and mitral valves.
Contrarily, color flow Doppler helps the cardiologist further evaluate the extent and direction of valvular regurgitation or abnormal flow patterns contributing to the murmur.
Applicable Modifiers for CPT Code 93325
Ensure coding specificity with appropriate modifier usage and supercharge your collections. Here’s a list of all applicable modifiers for the Doppler color flow study:
Modifier 26
Do you want to bill only for the professional component of CPT code 93325? Append modifier 26 when the cardiologist interprets the results and prepares the report but does not own the equipment.
Modifier TC
Typically, facilities that own the equipment append modifier TC to CPT code 93325 to bill for the technical component of the procedure.
Modifier 59
Append modifier 59 when the color flow Doppler is a distinct, separately identifiable procedure from other services rendered on the same day. This modifier helps you avoid payment cuts due to bundling issues.
Modifier 76
What happens when the same cardiologist repeats the color flow Doppler on the same day? You append modifier 76 to avoid claim denial due to duplication error.
Modifier 77
Append modifier 77 to CPT code 93325 when another cardiologist repeats the color flow Doppler on the same day.
Modifier 91
Modifier 91 applies to laboratory tests. However, it may apply to CPT code 93325. So, in what circumstances can you use it? When the cardiologist repeats the color flow Doppler for clinical reasons on the same day.
CPT Code 93325 – Billing & Reimbursement Guidelines
Discussed below are the key billing and reimbursement requirements related to the Doppler color flow study:
Ensure Coding Accuracy
Since CPT code 93325 is an add-on code, you cannot report it individually. Simply put, it is an enhancement of an echocardiogram procedure. Therefore, you should always report it with a primary echocardiographic examination, such as CPT codes 93303, 93306, 93308, etc.
However, do not confuse an add-on code with a bundling code. The Doppler color flow study is not bundled with the primary echocardiographic examination. As an add-on code, it is eligible for a separate reimbursement. However, payer policies can vary. Thus, we recommend you review the specific payer guidelines to understand the bundling rules surrounding CPT code 93325.
Demonstrate Medical Necessity
Let’s just say, establishing medical necessity is the cornerstone requirement for timely reimbursement. This requirement is the same across all insurance payers for all procedures. If your documentation fails to support the medical necessity of a procedure, the payer will deny the claim.
Therefore, you must document the medical indication for performing the add-on procedure (CPT code 93325) in the patient’s medical record.
Focus on Documentation Completeness
Provide adequate documentation to the payer with the medical claim. Your echocardiography report should include findings from both the 2D and Doppler examinations. Besides, it should have color flow mapping with a clear interpretation of the results.
Append the Appropriate Modifier
Modifiers are there to help you ensure coding specificity. However, you should not overuse or misuse these. The most common modifiers that apply to the CPT 93325 are TC and 26. Since the color flow Doppler procedure covers professional and technical components, you should append relevant modifiers while billing a single component.
Some other modifiers that apply to this procedure include 59, 76, 77, and 91. You can refer to the ‘Applicable Modifiers for CPT code 93325’ section of this guide for further information on the appropriate modifier usage.
Summary
Having covered all aspects of CPT code 93325 within this ultimate guide, it is time to wrap up! However, before we conclude, let’s quickly revisit everything we have learned. We explained that CPT 93325 is an add-on code that covers the Doppler color flow study. We also shared some clinical scenarios to help you understand where this CPT code applies. These include structural and hemodynamic evaluation, congenital heart defect assessment, and valvular regurgitation evaluation.
Moving forward, we discussed a list of all applicable modifiers for CPT 93325, including 26, TC, 59, 76, 77, and 91. Finally, we explained the billing and reimbursement requirements related to the Doppler color flow study. Hopefully, these details will help you overcome the billing intricacies surrounding this echocardiography procedure. However, if you require professional assistance, why not outsource cardiology billing services to MediBillMD?
