Cardiology

Cardiology Question for the Week of December 23, 2019

Cardiology Compliance Question of the Week

Question:

Do you have any guidance for codes 93303 and 93304?

Answer:

Do not use codes 93303 and 93304 when congenital heart disease is suspected but not found; codes 93306–93308 may be reported instead. (Source: CPT Assistant, May 2015, Volume 25, Issue 5, page 10)

  • For hospital-based services, on the CMS-1500 claim form, assign modifier 26 to describe the professional component. For Medicare patients, hospitals will not need to assign the TC modifier, as billing on the UB-04 claim form implies billing for the “technical component.”
  • If performed in a physician-owned, non-facility setting in which the physician owns the equipment, employs the staff, and performs and reads the study, no modifier is required as this constitutes global billing.

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