What Is the CPT Code for Echocardiogram?

Echocardiography is one of the most frequently used in cardiology, but the process for billing echocardiography can be a challenge because of the large variety of transthoracic versus transesophageal echocardiograms, various types of echocardiograms that are stress, Doppler, and congenital echocardiograms. Each of these various types of procedures can have multiple CPT codes that can have different levels of documentation required.

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This guide includes all the information that your office needs to know, including the correct CPT codes, what constitutes medical necessity from the payers' point of view, common denial mistakes, modifier requirements, and how technology systems such as RapidClaims are helping cardiology groups reduce the time from the completion of the echocardiogram procedure until the time of reimbursement.

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Understanding Echocardiography from a Billing Perspective  

An echocardiogram is an ultrasound test that generates real-time images of the heart's structure and function. A cardiologist may order an echo to diagnose valve problems, heart function, abnormal heart muscle movement, pericardial effusion, congenital heart defects, and other heart problems. The type of echocardiogram performed, the imaging components of the test, and the presence of a stress test in the echocardiogram all impact the CPT code that should be assigned to the test.  

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The CPT code system categorizes echocardiography into different categories. It is important to understand the category of the test because incorrect coding of transthoracic vs. transesophageal studies can lead to audits.

CPT Code for Echocardiogram: The Complete List

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Below is a structured breakdown of the primary echocardiography CPT codes currently in use:

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Transthoracic Echocardiogram (TTE) - Deep Dive on CPT Code 93306, 93307, and 93308

Transthoracic echocardiogram is the most frequently requested procedure. This procedure is a non-invasive diagnostic technique wherein a transducer is placed on the chest wall. To avoid underpayment and possible audits, healthcare professionals must understand the distinction between CPT Code 93306, CPT Code 93307, and CPT Code 93308.

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CPT Code 93306 - The Standard Complete Transthoracic Echocardiogram

CPT Code 93306 refers to the complete transthoracic echocardiogram with the inclusion of M-mode, two-dimensional, spectral Doppler, and color flow Doppler. This is the most commonly used CPT Code for the echocardiogram. For a CPT Code 93306 to be utilized for an echocardiogram (ECG/ECHO), all necessary components of the ECG/ECHO must be present. An example of components necessary for using a 93306 is: left ventricle measurements performed via M-mode; two-dimensional views of the heart; spectral doppler velocity and direction (e.g., direction & velocity) measurements of blood flow; and color flow doppler. The CPT Code 93306 cannot be used to bill for an ECHO that does not include all four components listed above.

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93307 – TTE Complete No Doppler

If a 2-dimensional and M-mode echo has been performed but the Doppler evaluation was either unintentional or impossible to perform, use the CPT code 93307 when billing for TTE. Although this occurrence occurs in many clinical settings, it is not an everyday scenario. Most often, this occurs when there are intrinsic quality limitations with the images that prevent the acquisition of reliable Doppler information. Insurers are more commonly examining claims submitted for 93307 to determine whether a Doppler evaluation was never documented, versus actually being done.

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CPT 93308: Follow-Up or Limited TTE

CPT 93308 is a follow-up echocardiogram specifically ordered to evaluate one specific heart structure OR to answer one specific clinical question, NOT to provide a complete evaluation. Examples of when a CPT 93308 would be appropriate include if a physician ordered an echocardiogram simply to monitor the size of a pericardial effusion or to evaluate one valve after having performed a complete echocardiogram previously. The CPT 93308 is NOT appropriate to be billed as a financial alternative instead of billing a complete echocardiogram when a complete echocardiogram has been performed.

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CPT Code For Stress Echocardiography - CPT 93350 And 93351  

The coupling of cardiac imaging and physiologic or pharmacologic stress to evaluate myocardial ischemia, abnormal myocardial contraction patterns due to stress, and valvular function due to stress is known as Stress Echocardiography. To ensure that the proper codes are billed for Stress Echocardiography procedures, it’s essential to have an understanding of how the codes should be used together as well as separately.

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The correct CPT code for a Stress Echocardiography procedure includes the following: 93350 and 93351. 93350 is the CPT code for a complete TTE exam with stress, either at the time of stress or after the application of exercise, or pharmacologic stress (as described above using dobutamine, adenosine, or regadenoson), and CPT code 93351 is the CPT code for the procedure when there is continuous ECG monitoring performed with the administration of stress. Only one of these codes should be reflected on each claim form.

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ICD-10 Diagnosis Codes for Echo Medical Necessity

Each claim for echocardiogram services requires one or more ICD-10-CM codes that validate the reason for performing the test. Payors, such as Medicare, use Local Coverage Determinations (LCDs) as key indicators of whether the diagnosis code supports the echocardiogram service provided.

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Modifiers for Echocardiogram Services

Modifiers provide additional information about the service provided, who provided the service, and how the service was provided. Some of the commonly used modifiers for echocardiogram services include:

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How RapidClaims Can Assist in Accurate Echo Code Billing for Cardiology Practices

Echocardiography billing can be difficult. There are many complex components to manage, like the use of multiple component codes and the rules for how to bundle or separate stress echo codes according to different payers’ LCD requirements. This often leads to billing errors for both novice and experienced teams, which results in delayed reimbursements and an increased likelihood of being audited when billing for these services. As a result, RapidClaims has an opportunity to create a significant advantage for cardiology practices.

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About RapidClaims

RapidClaims is a revenue cycle management platform powered by artificial intelligence and designed to mitigate claim errors, shorten the time it takes to receive reimbursement, and provide healthcare practices with live data tracking of their organization’s billing activity. When dealing with high complexity specialties like cardiology, where a single visit may result in multiple interrelated codes being utilized, the RapidClaims platform leverages machine learning models developed from the analysis of millions of claims to identify errors that manual reviews typically overlook.

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The complexities involved in billing echocardiograms require combinations of provider expertise, correct coding, and knowledge of multiple payers that are not needed to the extent required by other specialties. For example, in determining whether to bill for the echocardiogram CPT 93306 versus CPT 93307, whether Doppler was used or documented is the key differentiation. In determining whether to bill for CPT 93350 versus CPT 93351, the key differentiation is whether a continuous EKG was monitored during the study. The decision to bill with modifier -26 versus billing globally depends on who owns the equipment. None of these situations is based on randomness; they all stem from employed coders trained in these processes, documentation protocols that have clear requirements, and ideally have the technological systems that enable the coders to validate their decisions before claiming. 

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Increasingly, there are technology solutions like RapidClaims that can perform this function, minimizing errors that a human coder would make and making it possible to automate the more straightforward tasks associated with the billing process, allowing the trained staff to focus on the areas of greatest need. For large-volume echocardiogram groups, the combination of technology and trained staff will provide successful results for claims processing.

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FAQs

What is the CPT code for echocardiogram?

The commonly used CPT codes for a standard echocardiogram are 93306, which includes a complete transthoracic echo with spectral and color flow Doppler.
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What is the CPT code for stress echocardiogram?

CPT 93350 is used for a complete transthoracic echo performed at rest and with stress, where stress is either physical or pharmacologic in nature. CPT 93351 is used when there is continuous ECG monitoring performed in conjunction with the stress study. Additional codes are used for physician supervision, depending on the individual or group that interprets and/or performs each component of the stress echocardiogram.

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Which CPT code is used for complete echocardiogram?

The primary CPT code for a complete transthoracic echocardiogram with spectral and color flow Doppler is 93306. This code encompasses 2D, M-mode, spectral, and color flow Doppler echocardiogram for the evaluation of cardiac structure and function, including both the technical and professional components.