To ensure appropriate reimbursement for ECG studies, providers need to submit accurate codes, modifiers, and claims for services rendered.

1. Coding Accurately for
Echocardiography Services
Outsource Strategies International
United States
To ensure appropriate reimbursement for ECG studies, providers need to
submit accurate codes, modifiers, and claims for services rendered.

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Echocardiography (electrocardiogram) or the ECG test is an effective
diagnostic tool that uses ultrasound for the initial evaluation of many
cardiac signs and symptoms. ECG provides an excellent view of the
cardiovascular system. It provides speedy clinically relevant data cost-
effectively and with least stress to the patient. Echocardiography can be
completed more quickly than other imaging techniques. When it comes to
reporting echocardiography procedures, coding accurately is critical. In the
current scenario of declining reimbursement and increased scrutiny,
Outsourced medical billing services are a practical option for claims
processing and payment management.
The electrocardiogram can show:
- cardiac structure -- the size and shape of cardiac chambers
- function and morphology of cardiac valves – how well the heart is
working
- coronary artery disease and heart muscle disease
- presence of a blood clot
In patients already having cardiac disease, ECG is used to assess severity,
evaluate the results of medical and surgical interventions, and guide
procedures. It is also used in the evaluation of patients with electrolyte
abnormalities, drug toxicities, and implanted defibrillators. Echocardiography
is also an important tool to diagnose congenital and acquired heart problems
in infants and children.
Coding and Billing Echocardiography
The American Society of Echocardiography (ASE) and the American Medical
Association (AMA) continually review the Current Procedural Terminology
(CPT) and revise and add new codes. To ensure appropriate reimbursement
for ECG procedures and visits, practitioners need to stay up-to-date with the
changes and submit accurate codes, modifiers, and claims for services
rendered. The following is a list of CPT codes used to report
echocardiography in 2019:
Echocardiogram CPT Codes 2019
93350 transthoracic, real-time with image documentation (2D), includes M-
mode recording, when performed, during rest and cardiovascular stress test

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using treadmill, bicycle exercise and/or pharmacologically induced stress,
with interpretation and report
93351 transthoracic, real-time with image documentation (2D), includes M-
mode recording,…; including performance of continuous electrocardiographic
monitoring, with supervision by a physician or other qualified health care
professional
93303 Transthoracic echocardiography for congenital cardiac anomalies;
complete
93304 Transthoracic echocardiography for congenital cardiac anomalies;
follow-up or limited study
93306 Transthoracic, real-time with image documentation (2D), includes M-
mode recording, when performed, complete, with spectral Doppler
echocardiography, and with color flow Doppler echocardiography
93307 transthoracic, real-time with image documentation (2D), includes M-
mode recording, when performed, complete, without spectral or color
Doppler echocardiography
93308 Transthoracic, real-time with image documentation (2D), includes M-
mode recording, when performed, follow-up or limited study
93312 Transesophageal, real-time with image documentation (2D) (with or
without M-mode recording); including probe placement, image acquisition,
interpretation and report
93313 transesophageal, real-time with image documentation (2D) (with or
without M-mode recording); placement of transesophageal probe only
93314 transesophageal, real-time with image documentation (2D) (with or
without M-mode recording); image acquisition, interpretation and report only
93315 for congenital cardiac anomalies; including probe placement, image
acquisition, interpretation and report
93316 for congenital cardiac anomalies; placement of transesophageal
probe only
93317 for congenital cardiac anomalies; image acquisition, interpretation
and report only

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93318 transesophageal (TEE) for monitoring purposes, including probe
placement, real time 2-dimensional image acquisition and interpretation
leading to ongoing (continuous) assessment of (dynamically changing)
cardiac pumping function and to therapeutic measures on an immediate time
basis
93320 Doppler echocardiography, pulsed wave and/or continuous wave with
spectral display (list separately in addition to codes for echocardiographic
imaging); complete
93321 Doppler echocardiography, pulsed wave and/or continuous wave with
spectral display (list separately in addition to codes for echocardiographic
imaging); follow-up or limited study (list separately in addition to codes for
echocardiographic imaging)
93325 Doppler echocardiography color flow velocity mapping (list
separately in addition to codes for echocardiography)
93350 transthoracic, real-time with image documentation (2D), includes M-
mode recording, when performed, during rest and cardiovascular stress test
using treadmill, bicycle exercise and/or pharmacologically induced stress,
with interpretation and report
93351 transthoracic, real-time with image documentation (2D), includes M-
mode recording, when performed, during rest and cardiovascular stress test
using treadmill, bicycle exercise and/or pharmacologically induced stress,
with interpretation and report; including performance of continuous
electrocardiographic monitoring, with supervision by a physician or other
qualified health care professional
93352 Use of echocardiographic contrast agent during stress
echocardiography (List separately in addition to code for primary procedure)
93355 Transesophageal (TEE) for guidance of a transcatheter intracardiac
or great vessel(s) structural intervention(s) (eg, TAVR, transcatheter
pulmonary valve replacement, mitral valve repair, paravalvular regurgitation
repair, left atrial appendage occlusion/closure, ventricular septal defect
closure) (peri-and intra-procedural), real-time image acquisition and
documentation, guidance with quantitative measurements, probe
manipulation, interpretation, and report, including diagnostic

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transesophageal echocardiography and, when performed, administration of
ultrasound contrast, Doppler, color flow, and 3D.
Code Selection
Whatever the ultrasound equipment used, the physician should choose the
code that correctly describes the echocardiography exam performed and the
corresponding reason for the study (www.sonosite.com). The services
rendered must be documented in the patient's record.
93306 vs. 93308
When it comes to choosing the right echocardiography code, there is often
confusion about codes 93306 vs. 93308. The distinction between these
codes can be understood by carefully reviewing the descriptors.
Code 93306 describes a complete transthoracic echo with Doppler and color
flow.
According to CPT guidelines, “a complete transthoracic echocardiogram
requires 2-dimensional and, when performed, selected M-mode examination
of the left and right atria, left and right ventricles, the aortic, mitral and
tricuspid valves, the pericardium and adjacent portions of the aorta. (Note
that while M-mode exam is usually performed, it is not required in order to
assign a complete echo code.) If it is impossible to image all of the listed
structures, the report must indicate the reason. A limited transthoracic
echocardiogram should be billed if the report does not evaluate or attempt
to evaluate all of the structures listed above”.
CPT code 93308 represents a limited or follow up study:
93308 Echocardiography, transthoracic, real-time with image documentation
(2D), includes M-mode recording, when performed, follow-up or limited
study. This does not evaluate (or document the attempt to evaluate) all the
structures that comprise the complete echocardiographic exam, as outlined
in the CPT criteria, above. A limited study is typically confined to, or
performed in follow-up of, a focused clinical concern.
CPT Assistant (September 2005) also advises: [echo] “whether complete or
limited, includes an interpretation of all obtained information, documentation
of all clinically relevant findings including quantitative measurements
obtained, plus a description of any recognized abnormalities. Pertinent
images, videotape, and/or digital data are archived for permanent storage

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and are available for subsequent review. Use of echocardiography not
meeting these criteria is not separately reportable.”
Proper documentation is critical to ensure accurate code assignment.
Providers must also retain permanent images in the patient's record in order
to meet the criteria for billing echocardiography CPT codes. Outsourcing
medical billing and coding tasks to an expert medical billing company can
ensure claim submission to meet payer regulations and guidelines, which is
crucial for appropriate reimbursement.