We know how hectic it is for cardiologist to look after their patients and simultaneously deal with medical billing. Echocardiography is one of the common imaging tests in the United States. Approximately 7.1 million echocardiograms are conducted each year. Additionally, there are various types of echocardiography, so when cardiologists start billing, they must be aware of the specific CPT codes for each echocardiography process.
This blog outlines the complex billing requirements of CPT code 93350, which is a transthoracic echocardiography code. We will discuss the correct applications of 93350 with appropriate modifiers and insurance payers’ guidelines to help you collect your fair reimbursements.
CPT Code 93350 – Description
CPT code 93350 refers to transthoracic echocardiography. This real-time imaging test evaluates the heart function during periods of stress and rest.
This test utilizes ultrasound technology to produce comprehensive images of the heart’s structure and movement while the patient is in both resting and stressed states. The stress may be applied through physical activities such as walking on a treadmill or cycling, or through medications that recreate the heart’s response to exercise.
Transthoracic echocardiography delivers immediate, detailed views of the heart and is instrumental in evaluating its function and detecting the cardiac causes of chest pain, such as coronary artery disease or other heart-related issues.
Scenarios Where CPT Code 93350 is Applicable
The following are some of the applications of CPT code 93350.
Cardiomyopathy
Cardiomyopathy is one of the most common genetic diseases. Every 1 in 500 individuals has this disease. So let’s imagine a 55-year-old woman visits a cardiologist with various heart issues, such as chest pain, heart palpitations, and shortness of breath while doing house chores. She further reveals that cardiomyopathy runs in her maternal family. The cardiologist suspects the same in her, so he advises her to get an echocardiography while at rest and under stress. A healthcare provider conducts a thorough test at the hospital without interpreting the reports. So he can charge for his services with CPT code 93350.
Heart Valve Issues
Suppose a 60-year-old man with a history of high blood pressure is facing heart problems now. He goes to see a cardiologist and says that he randomly gets chest pain and gets a flip-flop feeling in his chest. The physician wants to see the real-time 2D images of the heart’s movement at rest and under stress. So he conducts a thorough transthoracic echocardiography. In this scenario, he can apply CPT code 93350 to receive reimbursement for his services.
Heart’s Function Post Surgery
Now, assume a 30-year-old man experiences symptoms like chest pain and shortness of breath. The physician conducts necessary tests and finds a pulmonary valve blockage. He cures this through a pulmonary valve surgery, clearing out the blockages. The patient comes back after six months for a follow-up on his surgery. The physician now conducts an echocardiogram to take images of his pulmonary valve and the movement of his heart in the resting position and at stress. To bill this service, he can apply the CPT code 93350.
Applicable Modifiers for CPT Code 93350
Most modifiers do not apply to CPT code 93350 due to its inclusive nature. However, you can append the following modifiers to specify the technical and professional components.
Modifier 26
You can apply modifier 26 to CPT code 93350 when a physician performs only the professional component of the transthoracic echocardiogram. So, if the physician only interpreted the images and provided reports, modifier 26 would be applicable.
Modifier TC
Modifier TC indicates the technical component of the service. You may apply the TC modifier to CPT code 93350 if your facility conducted the transthoracic echocardiogram and supplied the equipment, while another provider or entity handled the professional component.
CPT Code 93350 – Billing & Reimbursement Guidelines
The following medical billing and reimbursement guidelines can save you from unnecessary denials of CPT code 93350 claims.
Ensure Correct Use of CPT code 93350
CPT code 93350 is an all-in-one code. It is defined as “Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise, and/or pharmacologically induced stress, with interpretation”. It is an inclusive code that includes all the components of CPT code 93306-93308. Therefore, you cannot bill these codes together with CPT code 93350 due to its inclusive nature.
Provide Detailed Documentation
Proper documentation is the baseline to get the reimbursement for your services. It ensures the code accurately reflects the service provided. The insurance payer thoroughly reads the information provided in the documents and then decides the reimbursement charges for your services. Hence, missing out on any critical information from your documents may lead to reduced, delayed, or sometimes no payment. The following is a list of essential information that your documents must include:
- The relevant ICD-10 diagnostic codes
- Particular reason for the test performance
- Why was a stress echo chosen over an electrical stress test?
- Mention the referral order (written or verbal) in the patient’s medical record
- Interpretation and report
- Test frequency
- Necessity of test frequency
Prove Medical Necessity
An insurance payer requires the justification for the specific test or procedure. Therefore, it is essential to convey the medical necessity clearly in your documentation. You need to describe the reason for performing the particular procedure, including the patient’s current condition and medical history. Payers and auditors examine these records to verify that the test was suitable for the patient’s condition and that the associated costs are warranted. Otherwise, if your claims fail to justify the medical necessity through documentation, the insurance payer will deny your claim.
Avoid Billing CPT code 93350 with 93351
Coders often get confused between CPT codes 93350 and 93351. They usually apply both codes together on a claim when different providers are conducting a stress echocardiogram, but this is a major error in coding.
According to the AAPC guidelines, when the same physician renders the complete professional components of a stress test and a stress echocardiogram, you should report 93351 with modifier 26. However, if the professional services of a stress test are not all performed by the physician who conducts the stress echocardiogram, then you should report 93350 along with the appropriate bundling codes for the various components of the cardiovascular stress test.
Conclusion
In summary, you can use CPT code 93350 for billing a transthoracic echocardiogram, which includes assessments at rest and during stress. This test can be conducted for various reasons, such as evaluating heart function after surgery or identifying any irregularities in the heart structure. Additionally, you can bill the technical and professional components separately by appending the correct modifiers to this code.
If you feel that the information provided in this guide is insufficient for your billing needs, consider professional cardiology billing services. These services are offered by knowledgeable billers and coders who stay informed on the latest coding updates and policy changes. They can assist you in reducing the likelihood of claim denials.
