Diagnosis and CPT codes needed for proper coding of pediatric transthoracic echocardiograms for congenital abnormalities

Q.

This question pertains to a complete pediatric transthoracic echocardiogram. This procedure would be performed on a newborn of 21 days. Some articles say the first echo is defined by CPT^® code 93306, then, if diagnosed with a congenital anomaly, all follow-up echos would be assigned CPT code 93303.

The codes and full descriptions are as follows:

93303   Transthoracic echocardiography for congenital cardiac anomalies; complete

93306   Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

A.

First, determine why this this procedure was performed. Next, what were the findings.

According to the AMA, CPT Assistant (May 2015) notes that the congenital echocardiogram CPT 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 CPT code (93306–93308). If, however, a complex congenital condition is found, then your exam would be reported with CPT code 93303 or 93304. Note that when CPT code 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).