Cardiology Question for the Week of October 12, 2020

Question:

I just have a quick question on which charge is sent for a pediatric transthoracic echocardiogram complete. This would be on a newborn of 21 days. Some articles say the first echo is 93306, then if dx with a congenital anomaly, then follow-ups are 93303. What is your guidance?

Answer:

Why was it done? And what were the findings? According to the AMA, CPT® Assistant, May 2015 notes that the congenital echocardiogram codes 93303 and 93304 should not be used when complex congenital heart disease is suspected but not found on echocardiographic evaluation or for “simple” congenital anomalies such as patent foramen ovale (PFO) or bicuspid aortic valve. For those cases, you would report a non-congenital echo code (93306–93308). If, however, a complex congenital condition is found, then your exam would be reported with 93303 or 93304. Note that when 93303 or 93304 is reported, it should be linked to a diagnosis code from the ICD-10-CM section for congenital diagnoses (Chapter 17, Q codes).