Medical coding accuracy is vital to a practice’s revenue. Even small coding mistakes can lead to claim denials and significant revenue loss. That’s especially true for complex specialties, such as cardiology. Not only are cardiology claims challenging to bill, but they also have high denial rates.
A frequently used code in cardiology is CPT code 93307. It represents a specific kind of echocardiography. However, even experienced billing teams encounter challenges while filing claims for 93307.
That’s why we have created this detailed guide on CPT code 93307. So, let’s start.
CPT Code 93307 – Description
CPT code 93307 is defined as:
“Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography.”
Sounds hard? Let’s break this down in simpler terms.
93307 is used to bill a non-invasive cardiac imaging procedure. The procedure uses ultrasound technology to create detailed 2D images of the heart structures, like chambers, valves, walls, and surrounding vessels. Physicians use this procedure as a diagnostic tool to assess heart function, identify structural abnormalities, and monitor various cardiovascular conditions.
It may also incorporate M-mode recording for assessing motion over time. However, CPT code 93307 specifically does not include spectral or color Doppler echocardiography. These components are used to evaluate blood flow patterns, velocities, and directions within the heart and major vessels. If these studies are part of the procedure, other more relevant CPT codes like 93306 must be used.
The procedure typically takes 30-60 minutes to complete and is usually ordered for initial or follow-up evaluations in which a detailed study is not required.
Scenarios Where CPT Code 93307 is Applicable
Description alone is not enough for practical usage. So, let’s look at a couple of real-world scenarios in which CPT code 93307 can be used.
Syphilitic Endocarditis
Imagine a person in his mid-50s comes to a practice with a fever, heart murmur, and consistent fatigue. The patient also has a history of untreated syphilis. The physician suspects syphilitic endocarditis. This is an infection of the heart that affects the heart valves. However, before prescribing any treatment, the physician orders a transthoracic echocardiogram to confirm his diagnosis.
The test is performed and confirms the diagnosis. The billing team can bill the test with CPT code 93307.
Neoplasm of the Heart
A woman aged 50 is experiencing persistent chest pain, irregular heartbeats, and unexplained weight loss. After trying home remedies and some self-medication for two weeks, the pain worsens. She books an appointment with a cardiologist to get proper treatment. After examining the patient, the physician thinks the symptoms are vague and need clarification.
He orders a transthoracic echocardiogram to diagnose the root cause. The test results show a heart tumor. CPT code 93307 is used to report the echocardiogram performed.
Applicable Modifiers for CPT Code 93307
The following modifiers can be appended to CPT code 93307:
| Modifier | Description | When to Use |
|---|---|---|
| TC | Technical Component | Used when billing only for the technical aspects of the procedure (equipment, technician, supplies). |
| 26 | Professional Component | Used when the physician interprets the results but does not own the equipment. |
| 52 | Reduced Services | Used when the procedure is discontinued midway. |
| 59 | Distinct Procedural Service | Used when the procedure is distinct from other services performed on the same day. |
| 76 | Repeat Procedure by Same Physician | Used when the same physician repeats the procedure on the same day due to clinical need. |
| 77 | Repeat Procedure by Another Physician | Used when a different physician repeats the procedure on the same day due to clinical need. |
CPT Code 93307 – Billing & Reimbursement Guidelines
Discussed below are the billing and reimbursement guidelines for CPT code 93307:
Confirm Medicare Coverage
CPT code 93307 has a status code “A”, which means that Medicare separately provides reimbursement for it. However, an important point to note here is that echocardiography performed under code 93307 or other codes is not covered by Medicare for screening purposes. Additionally, Medicare does not reimburse for echocardiography for the following:
Routine yearly evaluations for asymptomatic patients with:
- Corrected Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), or Patent Ductus Arteriosus (PDA) (>1 year post-correction).
- Stable mitral valve prolapse with no/mild regurgitation.
- Mild aortic or mild-moderate mitral stenosis.
- Mild valvular regurgitation with normal LV size.
- Stable prosthetic valves without dysfunction.
- Stable heart failure or hypertrophic cardiomyopathy.
- Isolated APC/VPC without heart disease.
- Normal LV function (confirmed within the past year).
- Stable hypertensive heart disease.
Initial or specific evaluations for:
- Suspected pulmonary embolism (diagnosis).
- Native/prosthetic valves with transient fever, no bacteremia/murmur.
- Systemic hypertension without heart disease.
- Atrial fibrillation/flutter for thrombus/contrast (anticoagulation, no cardioversion).
Include Detailed Documentation
Proper documentation is a must to get your claim processed on the first try. For CPT code 93307, make sure to include:
- All the structural details of the heart and the relevant findings
- Clinical symptoms
- Relevant ICD-10 diagnosis codes
- Do not forget to mention that the procedure was performed without Doppler and color flow
- If a specific measurement is abnormal, explain what the abnormal value entails
Check the Reimbursement Rate
The reimbursement amount for CPT code 93307 varies greatly with MAC locality. However, Medicare’s national average rate for 93307 in non-facility settings is $131.00. The following is a breakdown of the amount based on technical and professional components:
- Professional component:
- Facility price: $41.40
- Non-facility price: $41.40
- Technical component:
- Non-facility price: $89.60
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
Let’s wrap up this guide. In this comprehensive guide on CPT code 93307, we have discussed what exactly the code entails, some usage scenarios, relevant modifiers, and the most important – billing guidelines. Here’s a quick recap:
Code 93307 is used to bill a transthoracic echocardiogram without Doppler or color study. The procedure may include M-mode recording. However, it is not compulsory. Depending upon the exact circumstances, you can use modifiers TC, 26, 59, and others for coding specificity.
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.
