Understanding the cardiology CPT codes descriptor is nothing short of navigating a maze. We know the struggle because, at MediBillMD, we deal with the cardiology billing requirements of healthcare providers across all fifty states of the US. Regardless of the complexities, our partnered cardiologists experience fewer denials, higher collection rates, and reduced A/R days, ultimately enhancing their practice’s overall revenue health.
Utilizing cardiology billing experience, our specialized team has penned down this guide to help you decode everything you need to know about the CPT code 93306.
So, without further ado, let’s get started!
93306 CPT Code – Description
This CPT code covers the transthoracic echocardiogram (TTE) complete with Doppler and color flow without contrast. In other words, the healthcare practitioner utilizes transducers to visualize the heart structure through the chest wall in two-dimensional (2D) images. The procedure also includes the anatomy and function evaluation of the heart’s valves, wall, adjacent aorta, and four chambers. Note that CPT code 93306 involves both the technical and professional components.
Scenarios Where CPT Code 93306 is Applicable
The below-mentioned scenarios will help you better understand CPT code 93306’s application in everyday clinical situations.
Heart Murmurs Assessment
Assume a patient visited a cardiologist for a routine checkup and discovered a heart murmur. For the unversed, a heart murmur is an unusual sound between heartbeats, typically heard as swishing or whooshing. It is due to the turbulent blood flow in the heart.
As a result, the cardiologist requested a TTE complete with Doppler and color flow without contrast to investigate the reason behind the murmur. Since an echocardiogram is a 2D imaging of blood flow patterns and heart valves, it will enable the healthcare provider to identify any structural abnormalities or valve dysfunction creating the murmur sound. Here, CPT code 93306 will apply.
Chest Pain Evaluation
Consider a patient who visits the ER with chest pain. The physician suspected a potential cardiac issue and requested a TTE complete with Doppler and color flow without contrast to assess heart structure and function, including blood flow, valves, and chambers. The report will help the healthcare practitioner determine whether the chest pain is due to a cardiac issue. Thus, CPT code 93306 will be reported here to ensure rightful payment for the echocardiogram.
Pre-Operative Cardiac Evaluation
Do you ever wonder what happens when a patient with a history of heart disease is scheduled for major surgery? The surgeon requests a TTE to assess the patient’s cardiac function before performing the procedure. This helps the surgeon identify any potential risks associated with the surgery and facilitates better pre-operative management.
Thus, if this TTE procedure is complete with Doppler and color flow without contrast, CPT code 93306 will be reported here as its descriptor precisely matches the performed echocardiogram procedure.
Applicable Modifiers for CPT Code 93306
Here are some of the modifiers that apply to the CPT 93306:
Modifier 26
You may append modifier 26 with CPT code 93306 if the healthcare provider only performed the professional component of the echocardiogram. Simply put, the provider only interpreted the test results and generated a written report but did not perform the test itself.
Modifier TC
Modifier TC is typically added with 93306 when the physician is billing only the technical component of the echocardiogram, which covers the equipment usage and conducting the procedure, excluding interpretation of the test results.
Modifier 59
This modifier indicates distinct procedural service. Therefore, you may use it with CPT code 93306 when the performed echocardiogram is a distinctively separate service from other procedures rendered on the same service date. It helps the payer know that the echocardiogram is a separate service and should be reimbursed separately rather than releasing a bundled payment for all services performed on the same day.
Modifier 76
If the echocardiogram covered under code 93306 is repeated on the same day by the same healthcare provider, you must append modifier 76 to ensure rightful payments.
Modifier 77
If the TTE complete with Doppler and color flow without contrast is repeated on the same day by a different physician, you may report the CPT code 93306 with modifier 77 to indicate to the payer that the repetition was necessary. As a result, the claim should be reimbursed accordingly.
Modifier 91
Modifier 91 is less common for echocardiograms such as the one covered under CPT 93306, but it can be applicable if the procedure is repeated for clinical reasons, i.e., for verifying the findings.
Modifier 52
If the echocardiogram was not completed or the scope was reduced, the CPT code 93306 must be reported with modifier 52. However, note that you can only use this modifier if a reduced-scope CPT code is unavailable. If another code precisely describes the extent of the performed echocardiogram, appending this modifier will result in claim denial.
Modifier 53
If the TTE procedure covered under CPT 93306 was started but discontinued due to patient safety or other unforeseen reasons beyond the physician’s control, modifier 53 must be added to the claim.
CPT Code 93306 – Billing & Reimbursement Guidelines
Discussed below are the billing and reimbursement guidelines for CPT code 93306:
Ensure Documentation Completeness
Detailed documentation is essential to get your claim processed on the first try. Thus, if you performed echocardiography with Doppler and color flow, and are reporting the CPT code 93306, you must ensure documentation completeness and accuracy.
The information that must be recorded and included with the medical claim is summarized below:
- Record all the structural details of the heart and the relevant findings.
- The structures may include any or all of these: left and right ventricles, mitral and tricuspid valves, left and right atria, the aortic, the adjacent portions of the aorta, and the pericardium.
- Do not forget to mention that the cardiologist performed the procedure with Doppler and color flow because it is a critical detail that differentiates the CPT code 93306 from 93307.
- Include information related to the hemodynamics and intracardiac blood flow.
- Document all the measurements that the cardiologist recorded from different heart views and interpret these measurements.
- While adding details related to the interpretation, specify whether the obtained measurement is within the normal range.
- If a specific measurement is abnormal, explain what the abnormal value entails.
Follow the Specific Payer Guidelines
Keep in mind that the reimbursement guidelines and billing requirements may vary across different insurance plans. Thus, it is critical to review the specific payer guidelines before submitting a claim against procedural code 93306 to secure timely reimbursements.
Append Appropriate Modifier
The correct modifier usage is one of the few best practices that confuse medical billers most. Since their addition is often situational, and your claim may not always require a modifier. Appending modifiers unnecessarily may also result in claim denials and other serious repercussions, such as financial penalties, reputation damage, audits, and lawsuits.
If you are unsure whether or not to append a modifier with CPT code 93306, refer to the previous section of this guide where we discussed the list of modifiers that support this CPT code in different situations.
Summary
With that said, let’s wrap up this guide! We discussed what the CPT code 93306 entails. We also shared some scenarios where this CPT code may apply. These include but are not limited to, pre-operative evaluation, heart murmurs assessment, and chest pain evaluation.
Moreover, we looked at some critical modifiers that may be appended to the echocardiography procedure to ensure rightful reimbursements, such as 26, TC, 59, 76, 77, 91, 52, and 53. That’s not all! We also shared the billing and reimbursement guidelines for reporting the CPT code 93306.
We hope this guide will help you implement effective billing best practices for a steady cash flow. However, if you find it challenging to handle the intricate billing and coding requirements in-house, we recommend outsourcing cardiology billing services to professionals like MediBillMD.
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