Healthcare providers performing echocardiographic procedures face numerous challenges. Why? Because small changes in the procedure may require a completely different billing and diagnosis code. Echocardiography is among the most confusing procedures to bill in cardiology.
CPT code 93320 is used for a specific part of echocardiography. It allows physicians to get a more detailed study of cardiac health when simple echo studies are not enough for diagnosis. In this blog, we have tried to simplify this code for you, so you don’t have to face any more denials.
So, let’s start.
CPT Code 93320 – Description
CPT code 93320 is defined as:
“Doppler echocardiography, pulsed wave and/or continuous wave with spectral display.”
The procedure involves a complete Doppler echocardiography. It is a specialized ultrasound technique that creates detailed 2D images of the heart. The Doppler technology is used to evaluate blood flow patterns, velocity, and direction within the heart and major vessels.
An important thing to note is that CPT 93320 is an add-on code with a “+” symbol. You cannot bill it separately. For proper billing, you must use this code with a primary echocardiographic imaging procedure code.
CPT code 93320 specifically uses pulsed wave and continuous wave Doppler examinations with spectral display. These methods are vital for detailed cardiac evaluations because they can provide a lot of information about cardiac output. They also help assess valve function.
Scenarios Where CPT Code 93320 is Applicable
Let’s discuss some applicable scenarios for CPT code 93320 to help you understand its appropriate usage in the real world.
Malignant Neoplasm of the Heart
Let’s consider an example of a cancer patient for this scenario.
Suppose a 65-year-old man visits his cardiologist. For the past few months, he has been feeling progressive shortness of breath and chest discomfort. The specialist performs all the basic evaluations that might explain the symptoms. However, during the assessment, he finds an abnormal cardiac mass. Upon further inquiry, the patient shares that he has also been experiencing unexplained weight loss and fatigue over the past three months. These symptoms, combined with the imaging findings, suggest a potential malignant neoplasm of the heart.
To confirm the nature of the cardiac mass and its effects on the blood flow, the physician orders a complete echocardiogram with Doppler assessment. In this case, CPT code 93320 is used along with CPT code 93307, which acts as the primary code for billing.
Vertebrobasilar Insufficiency
Another use of CPT code 93320 is for vertebrobasilar insufficiency (VBI) patients. Let’s consider a hypothetical scenario as an example.
Suppose a 58-year-old patient arrives at the emergency department experiencing dizziness, vertigo, and episodes of visual disturbances. The patient is also having difficulty maintaining her balance. The physicians in the ER try basic treatments for other common issues with the same symptoms. However, there is no improvement in the patient’s condition. This indicates that there is insufficient blood flow through the posterior circulation of the brain.
This could be due to cardiac sources of embolism or other more severe problems. So, to find the root cause of the problem, the physician orders a complete echocardiogram with Doppler evaluation. The billing department can bill the echocardiography with CPT 93320 along with a relevant primary code.
Applicable Modifiers for CPT Code 93320
The following modifiers are most commonly appended to CPT code 93320 to accurately describe the circumstances under which the physician ordered the add-on Doppler study.
| Modifier | Description | Usage Guidelines |
|---|---|---|
| TC | Technical Component | Designates billing for only the technical component, including equipment, supplies, and technician services. |
| 26 | Professional Component | Used when billing only for the physician’s interpretation and report of the Doppler echocardiography study. |
| 59 | Distinct Procedural Service | Used when CPT 93320 represents a separate and distinct service from other procedures performed on the same day. Requires proper documentation. |
| 76 | Repeat Procedure by Same Physician | Applied when the same physician repeats the procedure on the same day due to suboptimal results or clinical changes requiring repeat assessment. |
| 77 | Repeat Procedure by Another Physician | Used when a different physician repeats the procedure on the same date of service. |
CPT Code 93320 – Billing & Reimbursement Guidelines
Discussed below are the billing and reimbursement guidelines for CPT code 93320
Maintain Proper Documentation and Justify Medical Necessity
As we discussed above, CPT code 93320 is an add-on code. It must be used with an appropriate base code. It cannot be billed separately. The clinical record must clearly demonstrate why the spectral Doppler analysis was necessary beyond the basic echocardiographic imaging. Documentation should include specific clinical indications, patient symptoms, relevant physical examination findings, and how the spectral Doppler information will impact patient management decisions.
Additionally, the code must be supported with comprehensive documentation and a valid ICD-10 diagnosis code to justify the medical necessity. Some valid ICD-10 codes include:
- A18.84: Tuberculosis of the heart
- A41.4: Sepsis due to anaerobes
- G45.0: Vertebro-basilar artery syndrome
- G45.1: Carotid artery syndrome (hemispheric)
- G45.2: Multiple and bilateral precerebral artery syndromes
- G45.3: Amaurosis fugax
Check the Medicare Reimbursement Rates
The reimbursement amount for code 93320 is greatly influenced by the MAC locality and the appended modifiers. However, the national average reimbursement rate for 93320 is $48.52 for non-facility settings. The following is a more detailed breakdown of the cost structure:
- Professional component:
- Non-facility price: $16.82
- Technical component:
- Facility price: Not applicable
- Non-facility price: $31.70
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
In this blog, we tried our best to simplify CPT code 93320 for you. However, we realize that it is a lot of information to digest. So, let’s do a quick recap.
Code 93320 represents Doppler echocardiography with spectral display. It is an add-on code and cannot be billed separately. The code must always be used with a primary code and relevant modifiers (when necessary).
You can follow our guide to submit clean claims. However, if you are tired of constant denials, consider letting a professional handle your coding. Many companies, including MediBillMD, offer comprehensive cardiology billing services to help reduce your administrative workload.
