CPT Code 93306: Guidelines, Considerations, and Requirements

Did you know 93306 is among the leading CPT codes that are incorrectly assigned the most? We’ve written this blog specifically to prevent all the instances of its claims getting denied. We have discussed some key guidelines and billing considerations for you.

You can also find the major documentation requirements that will enable you to accurately assign this code. Also, Contact us to enlist our expert medical coders for your Cardiology Billing and Coding.

What Is CPT Code 93306?

The CPT code 93306 comes under the Echocardiography Procedures range. It is assigned to the echocardiography examination. You can assign this code whenever you have to use transducers to obtain 2D images.

The images obtained are of the heart structures through the chest wall. These images are used to evaluate the function and anatomy of the four heart chambers. You can also evaluate the associated valves, adjacent aorta, and the heart wall.

The full form of CPT in medical coding is Current Procedural Terminology. This name is associated with specific numeric codes that are assigned to medical services. Healthcare providers and insurance companies use CPT codes to identify those services while billing them.

Key Guidelines for Assigning CPT Code 93306

There are some key guidelines that you must follow while assigning the CPT code 93306. Let’s take a look at them in detail:

• Comprehensive Exam Required

You must assign 93306 only when a complete echocardiogram is performed. The procedure should cover all necessary imaging techniques. Those techniques include 2D imaging, M-mode recording, spectral Doppler, and color flow Doppler. You should ensure that the techniques capture the full structural and functional details of the heart.

Some of the major details comprise wall thickness, valve function, and blood flow. This code should be distinguished from other echocardiography codes. Those other codes cover only a limited view or partial procedure. Assigning 93306 implies the evaluation of the entire heart and related functions.

• Heart Structure Visualization

Another key guideline is capturing detailed images of the heart’s chambers under this code. Those chambers must comprise valves, pericardium, and adjacent structures. For this, you must assess the overall anatomy and health of the heart. Any abnormalities can also be detected like valve disorders, pericardial effusion, and cardiomyopathies.

Consider an example of a patient suspected of having heart failure or a valve issue. You can use 93306 to evaluate how well their chambers are pumping blood. You can also determine whether the valves are working correctly.

• Doppler Usage

Common Doppler techniques are spectral Doppler and color flow Doppler. These techniques should be conducted to analyze blood flow through chambers and valves. The Doppler component measures the speed and direction of blood flow.

]It helps detect issues like valve stenosis, regurgitation, and abnormal pressure gradients. This guideline ensures that CPT 93306 is assigned only when Doppler imaging is part of the study. It adds functional data to the anatomical images. It also gives a complete picture of how the heart is operating.

• No Separate Doppler Codes

Assigning this code includes the Doppler and color flow studies as part of the echocardiography exam. Therefore, you should not bill separate codes for these secondary procedures. Include everything under a single code to simplify billing. You can also avoid double-charging for these procedures.

• Patient History and Indications

This guideline requires the echocardiogram to be clinically justified. The justification should be based on the patient’s symptoms or history. Common indications for ordering this exam include chest pain, dyspnea, and irregular heartbeats.

There can be some known heart conditions as well like hypertension or cardiomyopathy. Proper documenting the medical history and symptoms enables you to support the medical necessity of a comprehensive echocardiogram.

• Trained Personnel

Echocardiography should be conducted by trained technicians or sonographers. You should ensure this especially for a complete study under CPT 93306. The interpretation and reporting must also be done by a qualified cardiologist or physician.

These qualified personnel should have specific expertise in echocardiography. This ensures accurate acquisition of the images and reliable interpretation of the findings. Inaccurate or incomplete studies could lead to missed diagnoses or improper treatment.

Billing Considerations for CPT Code 93306

You must also be aware of certain considerations while billing claims associated with the CPT code 93306. Here is a detailed explanation of the primary ones:

• Service Bundling

CPT 93306 is a bundled code for echocardiography exams. This means that it covers all aspects of a complete echocardiogram. Those aspects include 2D imaging, spectral doppler, and color doppler. These three aspects are bundled into one code. Therefore, separate bills for the doppler components are not allowed.

A provider may attempt to bill separately for these services. In this case, the claim may be denied or considered a billing error. Consider an example in which a 2D echocardiogram and a Doppler study are performed. In this case, you cannot bill 93306 along with 93320 and 93325. All services must be captured under 93306.

• Complete Study

CPT 93306 is specifically reserved for a complete transthoracic echocardiogram. This means the exam must include all necessary components. Those components are helpful in evaluating blood flow and velocity through the heart. A provider may perform only part of this study.

They should not just use CPT 93306. Instead, a more appropriate code like CPT 93308 should be billed. A patient may only require a quick check of one heart chamber or valve. Their provider might use the 93308 code instead of 93306. This code covers the entire heart.

• Separate Components

CPT 93306 can be broken into two separate components. The professional component is represented by the 26 modifier. It includes the interpretation and reporting of the echocardiogram. The technical component is represented by the TC modifier.

It includes the equipment, staff, and facility resources used to perform that exam. Some providers offer only one of these components. In such cases, they should use the appropriate modifier. Healthcare providers should bill the global code 93306 without modifiers.

They should ensure this if they are handling both components. A cardiologist in a hospital may only interpret the results. Their hospital should provide the equipment and staff. In this case, the cardiologist would bill 93306-26 and the hospital would bill 93306-TC.

• Frequency Limitations

Some insurance payers place limits on the billing frequency of echocardiograms within a given time frame. They place them to prevent unnecessary repeat testing. Providers must justify repeat echocardiograms within a short period.

They can do that by documenting significant changes in the patient’s condition. They can also provide the medical necessity of those repeated echocardiograms. Consider a patient who undergoes an echocardiogram on Monday. Then they have another one later in the week.

This one may only be covered if their condition worsens or if new symptoms emerge. A patient can have an echocardiogram for chest pain and develop additional symptoms a few days later. Their provider would have to document these new symptoms. This documentation will justify the need for another echocardiogram.

• Non-Covered Indications

The CPT code 93306 is not universally covered for all indications. For example, payers like Medicare may deny the claims ordered as routine screenings. They may not always have any specific medical indications. There must be a clear clinical reason for the study.

You may have to diagnose or monitor any known heart conditions. Routine exams without any documented symptoms or conditions are typically considered non-covered services. As a result, patients may be responsible for the costs unless special exceptions are made.

Consider a routine echocardiogram conducted on a healthy patient without symptoms. This echocardiogram is unlikely to be reimbursed. Some patients can have a heart murmur or show signs of heart disease. These cases are considered medically necessary and then covered.

Documentation Requirements for CPT Code 93306

Healthcare providers must also fulfill certain requirements in terms of their documentation. We have listed some of those requirements below:

• Complete Echocardiographic Study

One of the major imaging modes is 2D imaging. It creates two-dimensional pictures of the heart. It enables you to assess the structure and function of that organ. You must document the appearance of its key structures.

Some examples of structures are chambers, valves, and surrounding vessels. Another mode is M-mode imaging which captures the real-time motion of the heart structures. The motion is captured along a single scan line.

It provides key details about the movement of the heart walls and valves. This mode is useful for measuring dimensions and motion patterns. You must document your findings such as the thickness of the heart wall.

Doppler ultrasound measures the speed and direction of blood flow within the heart. In spectral Doppler, the velocity of blood flow is represented graphically. In color flow Doppler, you can show that velocity as color images over the 2D view.

• Anatomical and Functional Assessment

A physician must evaluate all the relevant heart structures. They should also document any key findings in their areas. Look for any enlargement or abnormal function that might indicate some threatening conditions.

Document wall thickness, size, and how well the ventricles contract. For instance, a thickened left ventricle might indicate hypertrophy due to high blood pressure. Each valve must be assessed for abnormalities. Stenosis or regurgitation are common issues that need to be documented.

The aorta and pulmonary arteries are key structures to examine for abnormalities. Their common abnormalities include dilation, aneurysm, and narrowing. This space around the heart is checked for the presence of pericardial effusion.

Its presence could signal inflammation or infection. Accurate measurements of the chambers and wall thickness are crucial. They help in diagnosing issues like cardiomyopathy. These issues are diagnosed where the heart muscle is abnormally thick or thin.

• Doppler Findings

The report must include a detailed account of the Doppler findings. It should reveal how blood flows through the heart. You need to document the direction and velocity of the blood flow. Any abnormalities such as regurgitation or stenosis must be documented as well.

Any additional Doppler-based information has to be present as well. Those details may indicate abnormal pressure gradients or flow patterns.

• Imaging Views

Standard echocardiographic views are used to ensure a complete examination of the heart. They include parasternal long/short axis views. These views provide a cross-sectional view of the heart. They enable you to evaluate the ventricles and valves.

The apical four-chamber view is taken from the apex (tip) of the heart. It gives a clear look at all four chambers. The subcostal view is taken from below the ribcage. It is often used to assess pericardial effusion or visualize the inferior vena cava.

• Interpretation

After collecting the data, you must provide a detailed interpretation of the findings. This includes identifying any structural abnormalities. They should explain any abnormal blood flow patterns detected via Doppler.

Summarize any noteworthy conditions or clinical implications of the echocardiogram findings. Your interpretation must comprehensively address all aspects of the study. The study should be performed by a qualified professional like a cardiologist.

The Bottom Line

This blog discussed the CPT code 93306 in detail so that you can assign it accurately. We covered some key guidelines for assigning it along with the billing considerations that you must follow.

There were also various documentation requirements mentioned that you have to fulfill. Contact Health Quest Billing to accurately assign more codes to your medical services along with 93306.