One of the main causes of death in the United States is cardiovascular disease. In 2022, 39.5% of deaths were from coronary heart disease (CHD). The rise in cardiovascular illnesses has left physicians overburdened with treatment and billing responsibilities. While they want to be paid fairly for their services, inaccurate billing acts as a barrier.
Therefore, we will discuss the CPT code 93308 (a cardiovascular code) today. This code is used by physicians to image a specific area of the heart in limited detail. However, if you want to familiarize yourself with billing and reimbursement guidelines for CPT code 93308, keep reading this blog.
CPT Code 93308 – Description
CPT code 93308 represents an echocardiography procedure, where the provider gets real-time two-dimensional (2D) images of the heart using ultrasound waves. The code is only used for a limited or follow-up transthoracic echocardiography (TTE).
So, in simple terms, 93308 is applicable when a healthcare provider conducts a restricted or follow-up TTE to acquire a 2D image of the heart through the chest wall. So, unlike a full echocardiogram, CPT 93308 represents a condensed analysis of a specific clinical issue without assessing or recording every cardiac structure. For example, it will offer a more targeted approach if the physician wants to evaluate a heart chamber or heart valves.
Note that CPT code 93308 covers both professional and technical components.
Scenarios Where CPT Code 93308 is Applicable
The following are some applicable scenarios for CPT code 93308.
Post-Surgical Evaluation
A 65-year-old male underwent valve surgery two weeks ago. Today, he visits the surgeon for a follow-up. The patient reports mild shortness of breath on exertion and occasional palpitations, without chest pain. The surgeon wants to evaluate valve function and rule out pericardial effusion without repeating the complete baseline study. Hence, he performs a limited transthoracic echocardiogram and bills his services with CPT code 93308.
Evaluation During Antineoplastic Chemotherapy
Suppose a 45-year-old woman with breast cancer is going through her antineoplastic chemotherapy sessions. Her current physician is aware that antineoplastic medications affect the left ventricular ejection fraction (LVEF) percentage and sometimes cause heart failure.
Echocardiographic assessments are crucial for detecting early cardiac changes and adjusting treatment before significant damage occurs. The oncologist recommends a targeted reassessment to check for changes in LVEF and overall cardiac function. Hence, a limited 2D echocardiography is performed and billed using CPT code 93308.
Follow-Up on Ongoing Cardiac Treatments
A 68-year-old female visits her nearest physician with a condition of shortness of breath. She usually wakes up at night gasping for air. Along with this condition, she has chest pain with heart palpitations. The physician asks her a few questions regarding her appetite and fatigue. Then, he conducts a limited transthoracic echocardiogram to evaluate blood flow in the heart and the percentage of left ventricular ejection fraction (LVEF). Since the provider has performed a targeted echocardiogram, he may apply CPT code 93308 for reimbursement of his services.
Applicable Modifiers for CPT Code 93308
You can apply the following modifiers to CPT code 93308.
Modifier 26
You can apply modifier 26 to CPT code 93308 if the physician is billing for the professional component of the echocardiography. It means he is seeking reimbursement for interpreting the echocardiograms and preparing a report, but not the technical portion of the test.
Modifier TC
If modifier TC is added to CPT code 93308, it means that the facility owned the equipment and carried out the imaging, but not the interpretation or reporting of the results. Therefore, the modifier highlights only the technical component of the transthoracic echocardiography.
CPT Code 93308 – Billing & Reimbursement Guidelines
If you want fair reimbursement for your services, then it is important that you remember the following billing guidelines for CPT code 99308.
Understand the Code
Understanding the description and the nature of the code is vital for all billers. While billing for CPT code 93308, it is important to remember that you cannot apply this code to complete diagnostic echocardiography. The code is only applied to limited and targeted echocardiography that is used to assess the condition of a specific part of the heart.
Provide Documentation
Every insurance payer wants the provider to submit detailed and correct documentation. The filed claims are immediately rejected if the supporting documentation contains false, incorrect, or missing information. The main requirement of your supporting documentation is that it must justify the medical necessity of the procedure.
Furthermore, the documents should highlight:
- Patient’s medical history
- Patient’s current condition
- The date of service
- The clinical evidence that supports the reason for a limited TTE
- Any abnormalities that were detected
- Details of the supervising physician
Follow the Frequency Limit
There is no limit set to the frequency of the procedure because it is a restricted, follow-up echocardiography. The number of tests depends on the patient’s health. Nevertheless, the documentation must indicate the justification for each procedure along with the relevant diagnostic code. Moreover, the biller should consult the Local Coverage Determinations (LCDs) established by the local insurance companies to see if they have imposed any restrictions on their service coverage.
Conclusion
We have covered nearly every aspect of CPT code 93308. Each coder or biller needs to understand how to apply this code correctly and provide detailed documentation to support its use. They must also be aware of the relevant modifiers and keep abreast of the insurance companies’ differing billing policies.
Fortunately, our blog has addressed nearly every detail. However, you can employ professional cardiology billing services for additional assistance and to improve your collections.
