Coding FAQs

2010/2013 Charts of Projected Payments by Code

*Please note this document contains two ‘sheets’. One using the 2009 conversion factor and the other using 2010 conversion factor.

New 2009 CPT Echocardiography Codes

ASE is receiving many inquiries from members requesting clarification of how to bill for various echocardiography services with the new 2009 codes. We have compiled this FAQ document to facilitate the integration of these codes into practice.

As described in the 2009 Coding Newsletter, ASE is continuing to work with the payer community to help resolve some additional questions about the application of these new CPT codes for both the hospital and physician.

TEE with Doppler and Color Doppler

Question: In 2008, we reported codes 93307 (2D), 93320 (Doppler) and 93325 (color Doppler) for a complete comprehensive echocardiogram. For 2009, what code do we report?

Answer: Report code 93306. This code includes all three elements, 2D Echo, Doppler and color Doppler. Codes 93320 or 93325 should not be reported with code 93306.

Question: Do Medicare payments for the new code 93306 reflect all three elements, 2D Echo, Doppler and color Doppler?

Answer: Yes, CMS has established the payment rate for 93306 to include all three elements.

Question: We now have to establish a new charge for code 93306. Should our charges for code 93306 reflect all three elements, 2D Echo, Doppler and color Doppler?

Answer: Yes, fundamentally, the charges for code 93306 should be the sum of the charges for 93307, 93320, 93325.

Question: I heard that payers other than Medicare have not implemented the use of code 93306.

Answer: Non-Medicare payers may be slow to implement the 93306 code but will eventually do so. If the code is not accepted at this time, check with provider relations to clarify if you should continue to code with 93307, 93320, and 93325.

Question: Will non-Medicare payers modify their payments when they implement code 93306?

Answer: Non-Medicare payer fee schedules and contracts vary. From a practical perspective, the charges for code 93306 should be the sum of the charges for 93307, 93320, and 93325.  Based on your current contract for 93307, 20, 25, one could assume the same payments for those codes would be applied to 93306, until your contract is renewed.  The critical piece to follow is that when the payer does establish a payment for new code 93306 it should be based on the sum of all of the parts (93307, 93320, 93325). It is important to check with your payers.

M Mode in the CPT code Descriptor

Question: Codes 93307, 93308 and 93350 descriptors were revised and now state “includes M-mode recording, when per­formed.” Is M mode required for these procedures?

Answer: No, the CPT code descriptor doesn’t require the performance of an M mode. If it is performed, the documentation should reflect the findings.

Question: Since Medicare no longer separately reimburses hospitals for outpatient color Doppler or spectral Doppler, should hospitals continue to report these codes (as previously done) when provided in the hospital outpatient setting?

Answer: Yes. Since the costs of the Doppler services are now packaged into the “base” echo procedural costs (since January 2008), it is crucial for hospitals to continue to report the provision of these services, using the existing codes. If hospitals discontinue reporting (and charging) for these services, CMS will assume that they are not being provided, potentially resulting in decreased payment allowances for the combined procedures.

In addition, the reporting of these services is necessary for maintaining reimbursement with private payers.

Note: Separate payment is allowed for the physician service when physician interpretation is done in the hospital/facility setting or procedures are done in the physician’s office.

 Stress Echo

Question: Can a stress echo (93350, 93351) and TTE be reported on the same date of service by a single physician? 

Answer: Transthoracic echocardiography (93303, 93304, 93306, 93307 or 93308) may be reported on the same date of service as a stress echo (93350 or 93351) for a different clinical circumstance. The modifier -59, Distinct Procedural Service, should be appended to the applicable TTE code.

Explanation:
•  Per the AMA CPT Introductory echocardiography language, stress echo codes (93350, 93351) include the acquisition of echocardiography images before, after, and in some protocols during stress.
• Per NCCI edits, stress echo codes 93350 and 93351 have a billing edit assigned to TTE codes that indicates that a modifier is allowed in order to differentiate between the services provided.

 NCCI Edits for Spectral and Color Doppler Explained

May 20, 2009
An erroneous Medicare NCCI billing edit prohibiting the payment of color Doppler when reported with spectral Doppler has been corrected by the Centers for Medicare and Medicaid Services (CMS). Color Doppler procedures should now be reimbursed.

For services billed by physicians, this edit was removed, effective April 1, 2009.  For services billed by hospitals, the edit will be deleted on June 30, 2009.

Background
The CMS developed the National Correct Coding Initiative (NCCI) edits as a means to control improper coding of services when performed by the same physician for the same patient on the same date of service. NCCI edits are used by Medicare and by many other payers including private health plans, managed care plans, and Medicaid agencies.

The NCCI edits consist of two tables (Column I and Column II) which list pairs of HCPCS and CPT codes that should not be reported together.   When both of the codes in the column pair are reported together, the code in column II is denied. Previous to January 1, 2009, no NCCI edits were listed for the pairing of spectral Doppler and color Doppler.  On January 1, 2009, spectral Doppler (93320) was listed in Column 1 and color Doppler (93325) was listed in Column II of the NCCI Version 15.0 table. This edit resulted in claim denials for color Doppler when the codes were reported with congenital TTE (93303, 93304), TEE (93312, 93314, 93315, 93317), and stress echo (93350, 93351).  These edits were applicable for both hospital outpatient and physician services. Note the NCCI edit was not applicable to TTE procedures reported with code 93306.

Actions
Communication with NCCI by ASE confirmed that the edits were in error and would be removed on the next NCCI quarterly updates.

What this Means to Hospitals and Physicians
Color Doppler and spectral Doppler may be reported in conjunction with congenital TTE, stress echo, and TEE services. For physician services, any claim denials for color Doppler when performed with spectral Doppler prior to April 1, 2009 can be resubmitted to obtain retroactive Medicare payment.  For hospitals, the quarterly update will go into effect on July 1, 2009 and claims that were previously denied may be resubmitted.

Other Payers
Hospitals and physicians should check to see if claims from other payers have been denied based on these erroneous NCCI edits.  Should that be the case, ASE recommends contacting those payers to determine if they will reimburse for those denied Doppler claims and if they have modified or will modify their billing systems to accommodate new quarterly NCCI updates that remove the pairing of spectral and color Doppler codes.