Question:

What constitutes a “congenital” disease for echocardiogram?  PFOs (patent foramen ovale) and bicuspid aortic valves are not considered “congenital” for cardiac catheterization, but I wasn’t sure if the same applied to echocardiograms.

Answer:

The American Medical Association has stated the same policy for congenital echocardiograms.  Here is some information from the May 2015 issue of CPT Assistant:

Question: My physician is a pediatric cardiologist who evaluates many infants and children for heart murmurs which can signal congenital heart defects. Part of the evaluation can involve the performance of a complete echocardiogram. Which CPT® code should be reported for this imaging study when the evaluation does not find evidence of congenital heart anomaly? Would CPT codes 93303–93304 be reported? This seems to be the correct code only when congenital anomalies of the heart are found.

Answer: Codes 93303, Transthoracic echocardiography for congenital cardiac anomalies, complete and 93304, follow-up or limited study 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. In these cases, the non-congenital echocardiography codes (93306–93308) should be used. Note: When a congenital procedure code is used, it should be “linked” to a congenital ICD-9-CM (or ICD-10-CM) diagnosis code in order to ensure appropriate claim processing.”


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CPT is a registered trademark of the American Medical Association.