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Cardiology CPT Codes – A Quick Reference for Billing and Coding

• Cardiology and Associated CPT Codes in Healthcare
• What is Cardiology in Healthcare?
• Specialized focus on heart and circulatory health.
• In-depth study and treatment of cardiovascular conditions.
• Wide array of medical procedures and diagnostic tests.
• What are Cardiology CPT Codes?
• Specific alphanumeric codes for cardiology procedures.
• Standardization within the Current Procedural Terminology.
• Facilitation of accurate billing and reimbursement in healthcare.
• Commonly Used CPT Codes in Cardiology

Going through the landscape of cardiology coding involves a thorough understanding of commonly used CPT codes for precise billing and reimbursement.

Here’s a brief overview of some key codes:

CPT Code 93010: This code involves the interpretation and reporting of electrocardiograms, providing crucial insights into cardiac health through diagnostic analysis.

CPT Code 93000: A routine electrocardiogram with a minimum of 12 leads, this code serves as a fundamental diagnostic tool for cardiac assessments.

CPT Code 93005: Specifically performed during initial preventive physical examinations, this routine electrocardiogram ensures comprehensive screening with a minimum of 12 leads.

CPT Code 93306: Designated for complete transthoracic echocardiography, this code aids in assessing congenital cardiac anomalies through detailed imaging of the heart.

CPT Code 93798: Includes physician’s cardiovascular stress test interpretation, vital for diagnosing and managing diseases through exercise-induced heart evaluations..

CPT Code 93325: Used for Doppler echocardiography, this code employs pulsed-wave and/or continuous-wave spectral display to provide detailed insights into cardiovascular function.

CPT Code 93296: CPT Code 93296: Focuses on programming implantable devices, ensuring optimal function through iterative adjustment by a qualified healthcare professional.

CPT Code 93015: Encompasses comprehensive cardiovascular stress tests using varied methods, supervised by a physician for a thorough assessment.

CPT Code 93018:  Addresses cardiovascular stress tests with exclusive pharmacological stress, offering valuable diagnostic information under physician supervision.

CPT Code 93017 : Involves cardiovascular stress tests with exercise, continuous electrocardiographic monitoring, ensuring a comprehensive evaluation of cardiac function.

Understanding commonly used CPT codes for cardiology evaluation and treatment is crucial for precise billing and reimbursement in healthcare. From interpreting electrocardiograms to overseeing cardiovascular stress tests, these codes play a pivotal role in diagnosing and managing diseases, ensuring accurate evaluations under medical supervision.

• Utilizing Evaluation and Management (E/M) Codes for Cardiology Services
• Effect of Inaccurate CPT Codes in Cardiology Medical Practice

Accurate CPT coding is pivotal in cardiology, yet the implications of inaccuracies reverberate through a medical practice.

Diminished Compensation: Errors in CPT codes impact reimbursement, directly affecting the financial stability.

Scrutiny and Fines: Incorrect coding triggers investigations, leading to financial penalties and resource-intensive resolutions.

Reputation Erosion: Coding mistakes tarnish the practice’s standing with insurers, hampering future reimbursement prospects.

Legal Entanglements : Coding inaccuracies may invite legal issues, fines, and exclusion from government programs.

Non-Compliance Challenges: Coding errors pose compliance issues, attracting financial repercussions and penalties under regulations like HIPAA.

Ensuring precision in CPT coding is not just about financial integrity; it safeguards reputation, compliance, and, most importantly, the standard of patient care.

• Documentation and Coding Guidelines in Cardiology Practice

1.Procedure Clarity:

Clearly articulate details of the performed procedure, specifying the approach, anatomical site, and any notable findings.

2.Clinical Justification:

Document the clinical necessity of the procedure, explaining its vital contribution to the patient’s diagnosis and treatment.

3.Time-Driven Services:

For time-sensitive services like stress tests, record the total duration, covering both service provision and supervision/interpretation time

4.Comprehensive Patient Details:

Capture a thorough overview of the patient’s condition, ensuring all relevant information supports services rendered and justifies specific CPT codes.

5.Thorough Recordkeeping:

Implement meticulous recordkee ping for accurate documentation, creating a transparent foundation for ethical cardiology billing practices.

• Effective Strategies for Maximizing Cardiology Reimbursement
• Accurate coding and documentation
• Proper use of modifiers
• Appealing denied claims
• Negotiating favorable payer contracts
• Staying informed about reimbursement policies
• Final Thoughts

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Healthcare Insights

Top 10 cardiovascular procedure codes

Published Mar 4th, 2024

According to the CDC, heart disease is the leading cause of death for people in the United States, representing one in every five deaths.

Considering how prevalent chronic heart conditions are, healthcare providers and businesses are working diligently to develop new treatments, devices, and drugs. Insights into cardiology and understanding which regions and populations may be most impacted by heart disease can help healthcare providers better understand which service lines to grow.

Below, we used the Atlas All-Payor Claims dataset to uncover the top 10 cardiovascular procedure codes performed in 2023.

Fig. 1 Data is from our Atlas All-Payor Claims dataset for calendar year 2023. Commercial claims data is sourced from multiple medical claims clearinghouses in the United States and is updated monthly. Data is accurate as of March 2024.

What were the top cardiovascular procedures performed in 2023?

Routine electrocardiograms (CPT Codes 93010, 93000, and 93005) held the top three positions for most cardiovascular procedures performed in 2023. This is unsurprising as ECGs are painless and noninvasive and are a common way to help many common heart conditions for people of all ages.

Rounding out the bottom three are a mixture of cardiovascular stress tests (CPT code 93015) and remote evaluations of implantable defibrillator systems or leadless pacemaker systems (CPT codes 93296 and 93294, respectively).

For more on the latest cardiovascular trends, check our Healthcare Insights on the top diagnoses by cardiologists and the top prescriptions by cardiologists .

What are the CPT codes for cardiovascular surgery?

According to the American Medical Association, the CPT codes for cardiovascular surgical procedures range from 33016 – 37799. Example procedures include implanting a pacemaker or defibrillator, coronary artery bypass grafting, excising a cardiac tumor, and many more.

What is heart disease?

Heart disease is used interchangeably with cardiovascular disease, and it describes the various conditions that affect your heart, heart rhythm, blood vessels, and more. Heart disease is one of the most common chronic conditions impacting population health , claiming the lives of more than 650,000 people each year.

Coronary artery disease (CAD) is the most common form of heart disease in the U.S. and occurs when a buildup of plaque cholesterol blocks the arteries that supply blood to the heart. CAD can lead to severe health issues such as an irregular heartbeat, chest pain, stroke, heart attack, and heart failure.

Healthcare Insights are developed with  healthcare commercial intelligence  from the Definitive Healthcare platform. Want even more insights? Start a  free trial  now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.

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• Top 10 Cardiovascular Procedure Codes

Follow these four steps to code quickly and accurately, while reducing the need to count up data points.

KEITH W. MILLETTE, MD, FAAFP, RPh

Fam Pract Manag. 2021;28(4):21-26

Author disclosure: no relevant financial affiliations.

The new rules for coding evaluation and management (E/M) office visits are a big improvement but still a lot to digest. 1 , 2 To ease the transition, previous FPM articles have laid out the new American Medical Association/CPT medical decision making guide 3 and introduced doctor–friendly coding templates (see “ Countdown to the E/M Coding Changes ,” FPM , September/October 2020), explained how to quickly identify level 4 office visits (see “ Coding Level 4 Visits Using the New E/M Guidelines ,” FPM , January/February 2021), and applied the new guidelines to common visit types (see “ The 2021 Office Visit Coding Changes: Putting the Pieces Together ,” FPM , November/December 2020).

After several months of using the new coding rules, it has become clear that the most difficult chore of coding office visits now is assessing data to determine the level of medical decision making (MDM). Analyzing each note for data points can be time-consuming and sometimes confusing.

That being the case, it's important to understand when you can avoid using data for coding, and when you can't. I've developed a four-step process for this (see “ A step-by-step timesaver ”).

The goal of this article is to clarify the new coding rules and terminology and to explain this step-by-step approach to help clinicians code office visits more quickly, confidently, and correctly.

The new evaluation and management office visit coding rules have simplified many things but are still a lot to digest, especially when it comes to counting data.

There are different levels of data and different categories within each level, which can make using data to calculate the visit level time-consuming and confusing.

By calculating total time, and then moving on to assessing problems and prescription drug management, most visits can be optimally coded without dealing with data at all.

OFFICE VISIT CODING RULES AND TERMINOLOGY

To make full use of the step-by-step process, we have to first understand the new rules, as well as coding terminology. Here is a brief summary.

Medically appropriate . Physicians and other qualified health care professionals may now solely use either total time or MDM to determine the level of service of an office visit. That means the “history” and “physical exam” components are no longer needed for code selection, which simplifies things. But your patient note must still contain a “medically appropriate” history and physical. So continue to document what is needed for good medical care.

New patient . A new patient is a patient who has not been seen by you or one of your partners in the same medical specialty and the same group practice within the past three years.

Total time and prolonged services . Total time includes all the time you spend on a visit on the day of the encounter (before midnight). It includes your time before the visit reviewing the chart, your face-to-face time with the patient, and the time you spend after the visit finishing documentation, ordering or reviewing studies, refilling medications, making phone calls related to the visit, etc. It does not include your time spent performing separately billed services such as wellness visits or procedures. Total time visit level thresholds differ for new patients vs. established patients. (See the total times in “ The Rosetta Stone four-step template for coding office visits .”)

The prolonged services code comes into play when total time exceeds the limits set for level 5 visits by at least 15 minutes.

Medical decision making . MDM is made up of three components: problems, data, and risk. Each component has different levels, which correspond to levels of service (low/limited = level 3, moderate = level 4, and high/extensive = level 5). The highest level reached by at least two out of the three components determines the correct code for the level of service. MDM criteria is the same for new and established patients.

Problems addressed . This includes only the problems you address at that specific patient visit. It does not include all the patient's diagnoses and does not include problems that are exclusively managed by another clinician. Problems addressed are separated into low-complexity problems (level 3), moderate-complexity problems (level 4), and high-complexity problems (level 5). To code correctly, you need to know the coding value of the problems you address. It is helpful to think of problems in terms of levels of service (e.g., a sinus infection is usually a level 3 problem, and pneumonia or uncontrolled diabetes are usually level 4 problems).

The simplest way to summarize problems is this: Life-threatening problems are level 5; acute or chronic illnesses or injuries are level 3 or 4 depending on how many there are, how stable they are, and how complex they are; and if there's just one minor problem, it's level 2.

(For more specifics see “ What level of problem did I address? ”)

Risk . Risk is also separated into “low” (level 3), “moderate” (level 4), and “high” (level 5) categories.

Level 3 risk includes the use of over-the-counter (OTC) medications.

Level 4 risk includes the following:

Prescription drug management: starting, stopping, modifying, refilling, or deciding to continue a prescription medication (and documenting your thought process),

Social determinants of health that limit diagnosis or treatment (this is when patients' lack of finances, insurance, food, housing, etc., affects your ability to diagnose, manage, and care for them as you normally would).

Level 5 risk includes the following:

Decisions about hospitalization,

Decisions about emergency major surgery,

Drug therapy that requires intensive toxicity monitoring,

Decisions to not resuscitate or to de-escalate care because of poor prognosis.

Data analyzed . For purposes of MDM, data is characterized as “limited” (level 3 data), “moderate” (level 4 data), or “extensive” (level 5 data). But each level of data is further split into Categories 1, 2, and 3. This can make calculating data complicated, confusing, and time-consuming. Here are the data components and terms you need to know.

Category 1 data includes the following:

The ordering or reviewing of each unique test , i.e., a single lab test, panel, X-ray, electrocardiogram (ECG), or other study.

Ordering and reviewing the same lab test or study is worth one point, not two; a lab panel (e.g., complete blood count or comprehensive metabolic panel) is worth one point,

Reviewing a pertinent test or study done in the past at your own facility or another facility,

Reviewing prior external notes from each unique source, including records from a clinician in a different specialty or from a different group practice or facility as well as each separate health organization (e.g., reviewing three notes from the Mayo Clinic is worth one point, not three, but reviewing one note from Mayo and one from Johns Hopkins is worth a total of two points),

Using an independent historian, which means obtaining a history from someone other than the patient, such as a parent, spouse, or group home staff member. (This is included in Category 2 for level 3 data, but falls into Category 1 for level 4 and 5 data.)

Category 2 data includes the following:

Using an independent historian (for level 3 data only),

Independent interpretation of tests, which is your evaluation or reading of an X-ray, ECG, or other study (e.g., “I personally reviewed the X-ray and it shows …”) and can include your personal evaluation of a pertinent study done in the past at your or another facility. It does not include reviewing another clinician's written report only, and it does not include studies for which you are also billing separately for your reading.

Category 3 data includes the following:

Discussion of patient management or test interpretation with an external physician, other qualified health care professional, or appropriate source. An external physician or other qualified health care professional is someone who is not in your same group practice or specialty. Other appropriate sources could include, for example, consulting a patient's teacher about the patient's attention deficit hyperactivity disorder.

A STEP-BY-STEP TIMESAVER

The majority of office visits can be optimally coded by using time or by looking at what level of problems were addressed (see Steps 1 and 2 below) and whether a prescription medication was involved.

A level 3 problem can be coded as a level 3 visit if you address it with an OTC or prescription medication. A level 4 problem can be coded as a level 4 visit if you order prescription medication or perform any other type of prescription drug management (modifying, stopping, or deciding to continue a medication). Most level 2 and level 5 office visits are straightforward, and most level 5 visits will be coded by time. They will typically be visits in which you address multiple problems or complicated problems and the total time exceeds 40 minutes for established patients. This is much more common than seeing critically ill patients who may require admission, which is another level 5 scenario. The few remaining patient visits that have not already been coded require analyzing data (Steps 3 and 4). (See “ The Rosetta Stone four-step template for coding office visits .”)

Step 1: Total time . Think time first. If your total time spent on a visit appropriately credits you for level 3, 4, or 5 work, then document that time, code the visit, and be done with it. But if it does not, go to Step 2.

Step 2: “Problems plus.” Don't be afraid to move on from time-based coding if you believe you performed a higher level visit using MDM. Many visits can be coded with MDM just by answering these two questions: What was the highest-level problem you addressed during the office visit? And did you order, stop, modify, or decide to continue a prescription medication?

If you addressed a level 2 problem and your total time was less than 20 minutes (or less than 30 for a new patient), then code level 2.

If you addressed a level 3 problem, plus you recommended an OTC medication or performed prescription drug management, then code level 3.

If you addressed a level 4 problem, plus you performed prescription drug management, then code level 4.

Chronic disease management often qualifies as level 4 work. For documentation, think “P-S-R”: problem addressed, status of the problem (stable vs. unstable), and prescription drug management (Rx). This trio should make it clear to coders, insurance companies, and auditors that level 4 work was performed.

For instance, if a patient has controlled hypertension and diabetes and you document that you decided to continue the current doses of losartan and metformin, that's level 4 (two stable chronic illnesses plus prescription drug management). If you see a patient with even one unstable chronic illness and document prescription drug management to address it, that's also level 4.

For a level 5 problem, if you see a really sick patient and decide to admit or consider admission (and you document your thought process in your note), then code level 5.

By starting with total time and, if necessary, moving on to “problems plus,” you will probably be able to optimally code 90% of your office E/M visits. But on the rare occasions when you see a patient for level 4 or 5 problems for less than the required time and don't do any prescription drug management, you may have to proceed to Steps 3 and 4.

Step 3: Level 4 problem with simple data or social determinants of health concerns . Code level 4 if you saw a patient for a level 4 problem and did any of the following:

Personally interpret a study (e.g., X-ray),

Discuss management or a test with an external physician,

Modify your workup or treatment because of social determinants of health.

Step 4: Level 4 or 5 problem with complex data . If you saw a patient for a level 4 problem and still haven't been able to code the visit at this point, you have to tally Category 1 data points:

Review/order of each unique test equals one point each,

Review of external notes from each unique source equals one point each,

Use of an independent historian equals one point.

Once you reach three points, code it as level 4.

For a level 5 problem, if you see a really sick patient, order/interpret an X-ray or ECG, and review/order two lab tests, then code level 5.

Following these steps should allow you to quickly identify the optimal level to code most any E/M office visit (for pre-op visits, see “ Coding pre-ops template .”)

Here's a catchy rhyme to remember the basic outline of the steps:

To finish fast ,

code by time and problems first ,

and save data for last .

By mastering the new coding rules and terminology and applying this four-step approach, you can code office visits more quickly, accurately, and confidently — and then spend more time with your patients and less time at the computer.

CPT Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services Code and Guideline Changes . American Medical Association. Accessed June 10, 2021. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

E/M Office Visit Compendium 2021. American Medical Association; 2020.

Table 2 – CPT E/M office revisions level of medical decision making. American Medical Association. Accessed June 10, 2021. https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf

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• Billing , Coding

Cardiology Medical Coding Cheat Sheet: Common Mistakes and Pitfalls

Melanie Graham

Although treatment has advanced leaps and bounds in the last few decades, heart disease remains the leading cause of death for U.S. adults. And with more than 20 million U.S. adults facing coronary artery disease, cardiology remains one of the busiest and highest-paid specialties . 

But high demand and top-tier salaries won’t matter much if your private cardiology practice has a problematic revenue cycle. Cardiology is a complex field with ever-changing treatments and procedures. That means keeping track of new cardiology medical billing guidelines and medical coding best practices, which can sometimes vary across payers. Even a solid claim scrubbing process may not catch every slip-up. 

Fortunately, following a few crucial cardiology billing tips (like those outlined in the cheat sheet below) can help your practice reduce costly errors and ensure a healthy revenue cycle management (RCM) process .

Cardiology Billing Guidelines and Coding Cheat Sheet

Keeping track of cardiology CPT codes and billing best practices is far from easy. We’ve put together this short cheat sheet with a few basics for cardiology medical billing. You can download the full cheat sheet here . 

Common Mistakes and Pitfalls in Cardiology Billing and Coding

Like many medical specialties, cardiology coding, claims and reimbursement can get complex. Below are some of the common cardiology billing challenges your team may encounter.

Not Checking Coverage Guidelines Before Procedures and Tests

One of the most common mistakes with cardiology billing is forgetting to check a patient’s specific coverage guidelines for a procedure or test. Missing this important step can pose problems for the patient and the practice. Reimbursement could be at stake, and patients may feel confused or frustrated when they receive a surprise bill for their care.

Beyond insurance eligibility , it’s also important for your team to check coverage guidelines before a cardiology procedure or test. You’ll need to make sure all prior authorizations, referrals or pre-certifications are in place before the scheduled procedure. Each payer will have specific guidelines, so understanding the intricacies of the patient’s plan is critical for a smooth claim filing process. 

Not Coding for Comorbidities

Cardiology patients often face more than one diagnosis, also called comorbidity. Common heart disease comorbidities include diabetes, high blood pressure (hypertension) and COPD.

When it comes to cardiology billing and coding, it’s important to document these comorbidities to help ensure your practice gets reimbursed as much as possible. You can document diseases separately or use ICD-10-CM combination codes.

ICD-10-CM stands for the International Classification of Diseases, Tenth Edition, Clinical Modification . Like CPT codes, ICD-10-CM allows physicians to speak a common language for diagnoses.

When documenting different diagnoses, check the coding instructions and read the code descriptions carefully. In some cases, you may need a combination code. A combination code helps classify multiple diagnoses, a diagnosis with a complication, or a diagnosis with a secondary manifestation. For example, a patient whose heart failure was caused by hypertension.

Schedule a Risk-Free Medical Billing & Revenue Cycle Analysis Today!

Not adding the proper modifiers.

Cardiology codes often include modifiers at the end. Modifiers are two-digit codes that show you’ve somehow altered the service in the original five-digit CPT code. 

For example, you may add modifier 25 to a patient visit where the clinician determined the patient needed a stress test at the end of the visit. Modifier 25 is for “significant and separate evaluation and management (E/M) on the same day as another procedure or service.” You would add “-25” to the end of the CPT code for the patient visit. 

Not using modifiers properly could result in lost revenue for your practice. In the example above, forgetting the “25” modifier may mean you miss out on reimbursement for the patient visit. Instead, the payer may lump together the visit with the stress test procedure. 

Other common cardiology modifiers include:

• 22 – Increased procedural services
• 51 – Multiple procedures done at the same time
• 52 – Reduced services
• 53 – Discontinued procedure

For more information on modifiers, download our Cardiology Billing Cheat Sheet .

Not Being Specific with Your Coding

Every cardiology condition has various options for diagnosis code. Coding mistakes often happen when you choose a code that isn’t specific enough for the diagnosis. 

For example, the ICD code for unspecified systolic congestive heart failure (150.2) differs from the code for combined systolic and diastolic congestive heart failure (150.4). 

Coding for the Symptoms and Not the Diagnosis

Often, cardiology coders submit symptom codes in addition to or instead of diagnosis codes. For the best possible reimbursement, only submit symptom codes if they are unrelated to the diagnosis. For example, if a patient is diagnosed with angina, you don’t need to submit a code for chest pain.

How to Prevent Cardiology Claim Denials

A claim rejection or denial will slow down your cardiology practice’s RCM process, which ultimately means a longer time to get paid. Avoiding these issues on the front end of your RCM can make a big difference to your bottom line.

Here are a few tips on how to prevent cardiology claim denials.

Know Payers’ Billing Guidelines and Set Up Rules for Unique Edits

Every payer is different, so you must understand the billing and coding intricacies for each. Understanding the unique guidelines can help avoid denials and delays in payments. 

If you have a payer with a unique billing protocol or code edit that your team is repeatedly entering, find an RCM tool that can automate this process. With the Gentem platform , for example, you can work with our team to create edits for specific claims or payers, which saves time and reduces the chance of manual error.

Keep Thorough Documentation

It’s always a good idea to keep detailed documentation for each patient, including symptoms, diagnoses, comorbidities, tests and treatments. Make sure you keep track of all patient encounters and avoid waiting too long between the date of service (DOS) and entering charges (also called charge lag). 

Having thorough notes will help your practice with pre-authorizations or certifications, as some payers require comprehensive patient notes. The notes will also help your practice if needs to appeal any claim rejections or denials. 

Modernize Your Billing and RCM

Learn how Gentem’s technology can save your organization time and increase revenue. Schedule a demo with our team today.

Create an Accurate Eligibility Check Routine

Verifying a patient’s insurance eligibility is an essential first step in the RCM and claim submission process. Your claim may not get very far if a patient doesn’t have an active insurance plan. 

It’s a good idea to set up a process where you can automatically check upcoming appointments. For example, the workflow could check eligibility for the following week’s schedule, giving your team plenty of time to reach out to patients if there are insurance issues. A tool with batch eligibility check features can save your team time, too.

Take Steps to Avoid Human Error

With so many twists and turns to cardiology billing, it comes as no surprise that simple human error is often the biggest hurdle to a clean claim process. With that in mind, make sure you:

• Work with a billing and coding team that has experience in cardiology
• Audit your RCM and billing process often to find patterns and errors that may be affecting your cash flow
• Set up a thorough review and claim scrubbing process
• Partner with a smart RCM software solution that provides automated workflows to reduce the likelihood of human error

Get additional best practices in our full Cardiology Billing Cheat Sheet.

Cardiology CPT Codes

The CPT codes for cardiovascular procedures typically range from 92920 to 93793. Some common cardiology CPT codes include:

• 93010: Electrocardiogram (ECG or EKG), routine with at least 12 leads
• 93798: Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)
• 93015: Cardiovascular stress test using treadmill or bicycle exercise, continuous ECG monitoring with supervision, interpretation and report
• 93306: Echocardiogram (Echo) where the provider uses a transducer to get a 2D picture of the heart through the chest wall (transthoracic).

Get more cardiology CPT code ranges in our Cardiology Billing Cheat Sheet .

Find a Partner Who Can Modernize Your Cardiology RCM and Billing Process

Efficient and accurate coding is one piece of healthy revenue cycle management and crucial to the success of your cardiology practice. Billing and coding mistakes can get expensive and ultimately affect the viability of your practice.

Keeping up with CPT and ICD code changes is helpful, as well as having experienced and knowledgeable coding staff. Efficient and effective billing processes can also go a long way in helping your bottom line.

If you’re finding it difficult to get full reimbursements for your cardiology care, Gentem’s AI-powered revenue cycle management (RCM) platform can help you improve your billing process and submit cleaner claims. We’ve helped cardiology practices increase collections, allowing them to expand staff and care for more patients. 

Book a demo today to learn more about our powerful RCM and billing tools .

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• Coding Made Simple: A Breakdown of Cardiology CPT Codes
• Posted on September 14, 2023
• Leave a comment

Cardiology is a medical specialty that relies heavily on different diagnostic tests, imaging studies, and interventional procedures to assess and treat conditions related to the heart and circulatory system. Many CPT codes apply specifically to the types of services performed by cardiologists and cardiology practices. Properly using these cardiology CPT codes is crucial for appropriate reimbursement and to convey the complexity of care provided.

This blog post will overview the most frequently used CPT codes in cardiology. We’ll describe the codes with their application and any special billing tips or recent changes. Whether you are a cardiologist, work in a cardiology practice, or are responsible for cardiology medical billing and coding, understanding these key cardiology CPT codes is essential for your reimbursement and compliance.

Most Common Cardiology CPT Codes

Some of the most common cardiology CPT codes relate to electrocardiograms (EKGs), echocardiograms, cardiac catheterization, and stress testing. However, new codes are introduced over time with advancements in the field. Cardiology providers and medical coders must stay up-to-date on CPT codes and billing guidelines.

Electrocardiograms (EKGs) CPT Codes

93000 is one of the most commonly used codes in cardiology. It is used for routine EKG tracing and interpretation. This basic EKG code is used for routine annual exams, pre-operative clearance, and evaluating cardiac symptoms like chest pain, heart palpitations, dizziness, or syncope.

93005 is used for electrocardiogram tracing only, without interpretation and report. It allows separate billing for the EKG trace, which a cardiologist sometimes interprets later. The tracing-only code can be used when one provider performs the EKG trace recording, and another interprets it separately.

93010 is used when an interpretation is done from an already performed tracing. The interpretation and report code is used when a provider reviews and analyzes a tracing that was already completed. This often occurs when a cardiologist is consulted on an EKG done elsewhere.

93040 (rhythm ECG, one to three leads, with report) is used for enhanced rhythm EKGs that monitor cardiac rhythms over an extended time.

Echocardiogram CPT Codes

CPT code 93306 (Echocardiography, transthoracic) is the most common echocardiogram code for imaging the heart’s structure and function using ultrasound waves passed over the chest wall. CPT code 93306 is used for evaluating heart function, looking for valve disorders, assessing chamber size, calculating ejection fraction, and detecting abnormalities in heart structure.

93307 (Echocardiography, complete, without spectral Doppler) is for a full transthoracic echocardiogram without the Doppler assessment. 93308 (Echocardiography, limited, without spectral Doppler) code is used for focused or limited imaging of certain heart structures. 93307 and 93308 are often used to quickly assess known issues like post-surgery or post-MI evaluation of heart function.

Cardiac Catheterization

93452 (Left heart catheterization including imaging) involves catheterization of the left side of the heart, often coupled with angiography.

93453 (Combined right and left heart catheterization) code includes catheterization of both sides of the heart in the same procedure.

93456 (Left heart catheterization for congenital disabilities) is used for patients with congenital heart defects.

93458 (Left heart catheterization for acquired defects) is used for patients with acquired defects like coronary artery disease.

Stress Testing

93015 (Cardiovascular stress test using exercise and EKG monitoring) is the most common type of cardiac stress test. Exercise stress testing is commonly done to induce ischemia in patients with coronary artery disease and evaluate EKG changes.

93017 (Cardiovascular stress test with EKG monitoring and administration of the drug) is for pharmacologic stress testing. Pharmacologic stress testing is preferred for patients unable to exercise adequately on the treadmill.

Billing Tips and Modifiers

Modifiers are essential for delineating professional vs. technical components and bypassing bundling issues when performing multiple cardiac procedures—accurate use of modifiers results in better claim reimbursement.

Herein are some tips regarding the modifier’s usage in cardiology billing:

Electrocardiograms

• Modifier 59 can be added to cardiology CPT codes 93000 or 93010 when an EKG is performed in addition to an E/M service on the same day. This avoids bundled payment.
• Modifier 26 is used with 93005 when only the professional component of an EKG trace is being billed separately.

Echocardiograms

• Modifier 26 is added for professional component billing only.
• Modifier TC is only applied for technical component billing by the facility/equipment with an echocardiogram CPT code.
• Modifier 59 may be needed if a diagnostic Cath is bundled with a surgical intervention.
• Modifiers LC, LD, RC, and LD define vessel(s) imaged during angiography.
• Modifier 22 is used to indicate increased complexity for congenital disabilities.
• 93015 and 93017 need modifier 26 when only the professional component is billed.
• Modifier TC is used if only the facility billed the technical component.
• Modifier 59 may be required if a stress test is done with other cardiac procedures.

Recent Changes to Codes

Staying current with new and updated CPT codes is essential in cardiology to capture reimbursement for the latest procedures and technology improvements. Regular code updates from the AMA and CMS keep cardiology billing aligned with the rapid pace of advancement.

Code 93X34 was introduced for prolonged external ECG patch monitoring exceeding 48 hours. This new code reflects the extended EKG monitoring now possible with patch devices. January 2022 added codes for cardiac magnetic resonance imaging (MRI) with contrast – 75561, 75563, and 75564. This provides more specific coding for cardiac MRIs beyond the previous broad MRI codes. Code 93356 was created in 2022 for transesophageal echocardiography for congenital cardiac anomalies. This includes differentiation from the standard TEE code 93355. January 2022 introduced +93600 intracardiac echocardiography during therapeutic/diagnostic intervention. This reflects the increasing use of ICE during procedures like Ablation.

See Also: Mental Health Billing: A Complete Guide

Proper application of CPT codes is vital for cardiology medical billing and reimbursement. As cardiology is a fast-evolving medical specialty, new codes are introduced frequently to keep pace with technological advances. Some of the most common cardiology CPT codes relate to EKGs, echocardiography, cardiac catheterization, and stress testing. However, there are many specific codes for emerging techniques like cardiac MRI, CT angiography, intracardiac echocardiography, and newer interventional procedures. Accurate coding requires understanding what each code represents and when to apply the correct code.

Keeping up with cardiology CPT code changes, additions, billing tips, and modifier usage is essential but challenging. This is where the experienced medical billing and coding team at Precision Hub can help. Our team specializes in cardiology and is up-to-date on the latest coding protocols. We handle all aspects of cardiology medical billing. With Precision Hub as your cardiology medical billing partner, you can rest assured your practice is coding properly and optimizing revenue. Our team stays on top of updates related to cardiology CPT codes so you can focus on delivering excellent patient care. Contact us today to learn more about our medical billing and coding services.

CPT Codes for Urgent Care: Guidelines 2023

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My name is Simon and I hold a PhD in Medical Sciences. I bring to Precision Hub my seven years of exposure. As a medical writer, I have contributed to industries as vast as medical devices & med-tech, pharmaceuticals, healthcare agencies, hospitals, health tech firms and healthcare communication agencies.

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• Cardiology Coding Center

Coding and RVU for cardiology procedures related to the following

Right Heart Cath

Left heart cath

Left and Right Heart Cath

Left Heart Cath Misc

Coronary Imaging

Coronary Intervention

Structural Heart Procedures

• Combined Right and Left Heart Catheterization CPT Codes and RVU
• Coronary Intervention CPT Codes and RVU
• Echocardiography CPT Codes and RVU
• Left Heart Catheterization CPT Codes and RVU
• Left Heart Catheterization Miscellaneous CPT Codes and RVU
• Right Heart Catheterization CPT Codes and RVU
• Structural Heart Intervention CPT Codes and RVU
• Coronary Artery Imaging CPT Codes and RVU
• 99233 CPT Code, Level 3 Hospital Followup Note –Dummies Guide 2017-2018
• 99232 CPT Code, Level 2 Hospital Followup Note –Dummies Guide 2017-2018

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Appropriate Use of Modifier 25

The Current Procedural Terminology (CPT) definition of Modifier 25 is as follows:

Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional. The American Medical Association (AMA) Current Procedural Terminology (CPT) book defines Modifier 25 as a significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding Modifier 25 to the appropriate level of E/M service. Note: this Modifier is not used to report an E/M service that resulted in a decision to perform surgery, see Modifier 57. For significant, separately identifiable non-E/M services on the same day, see Modifier 59.

There are several nationally recognized sources of information on the Modifier 25. The Centers of Medicare and Medicaid Services (CMS) requires that Modifier 25 should only be used on claims for E/M services, and only when these services are provided by the same physician (or same qualified nonphysician practitioner) to the same patient on the same day as another procedure or other service.

Here is an example of an appropriate use of Modifier 25:

Example 1: A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol. After the physician completes an office visit it is determined that the patient needs a cardiovascular stress test that is performed that day by the same physician.

Coding for Example 1: The physician or other qualified healthcare provider codes an E/M visit (99202 – 99215) and the physician or other qualified healthcare provider also codes for the cardiovascular stress test (93015). The Modifier 25 is added to the E/M visit to indicate that there was a separately identifiable E/M on the same day of a procedure.

• Coding example:

99214 – Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

93015 – Cardiovascular stress test

The modifier stops the bundling of the E/M visit into the procedure. When reviewing the physician’s documentation, the carrier should be able to determine that both the E/M and the procedure were medically necessary. As always, the documentation must support the claim that your office sends to the insurance carrier.

Some Examples of When Not to Use the Modifier 25

• Do not use a 25 Modifier when billing for services performed during a postoperative period if related to the previous surgery.
• Do not append Modifier 25 if there is only an E/M service performed during the office visit (no procedure done).
• Do not use a Modifier 25 on any E/M on the day a “Major” (90 day global) procedure is being performed.
• Do not append Modifier 25 to an E/M service when a minimal procedure is performed on the same day unless the level of service can be supported as significant, separately identifiable. All procedures have an “inherent” E/M service included. See example #2.
• Patient came in for a scheduled procedure only

Example 2: When a patient is scheduled to come into your office for a cardiovascular stress test and the physician also completes a history and performs a limited examination (specifically related for the stress test) your office should only code for the cardiovascular stress test (93015).

Coding Example: 93015

A Few Rules to Remember When Using the Modifier 25

• Modifiers are needed to inform third-party payers of circumstances that may affect the way payment is made – the modifiers tell a story of what is being done!
• Always link the modifier to the E/M CPT code
• It is not necessary to have two different diagnosis codes
• Need to document both the E/M and the procedure

Per the NCCI general correct coding policies, Modifier 25 may be appended to E&M services reported with minor surgical procedures (global period of 000 or 010 days) or procedures not covered by global surgery rules (global indicator of XXX). Since minor surgical procedures and XXX procedures include pre-procedure, intra-procedure, and post-procedure work inherent in the procedure, the provider should not report an E&M service for this work. Furthermore, Medicare Global Surgery rules prevent the reporting of a separate E&M service for the work associated with the decision to perform a minor surgical procedure whether the patient is a new or established patient with the decision to perform surgery the same or next day.

One Last Note

When you submit a claim to the insurance carrier that is coded with a 25 Modifier, you are telling the carrier to pay you for both the E/M visit and the minor procedure. Often in the past claims with both an E/M and procedure have been reviewed for accuracy. When you bill both codes on the same day will your documentation support both codes? Will you have documented adequately for the E/M separate from the procedure? Typically, when these services have been audited payment was rescinded due to incorrect coding, incomplete documentation, and/or lack of medical necessity to support both codes billed on the same day by the same physician.

Modifier 25 can be used for outpatient, inpatient, and ambulatory surgery centers hospital outpatient use.

Modifier 25 can be used in other situations such as with critical care codes and emergency department visits.

Please reference the 2021 AMA CPT coding book for full definition of the codes.

For further information on level of service please see the CMS E/M coding guidelines for ’95 and ’97 at the websites listed below.

• AMA CPT 2021 Coding Book
• AMA Principles of CPT Coding
• CMS E/M Services Guide
• National Correct Coding Initiative Edits
• Evaluation and Management Services Guide
• CMS Medicare Claims Processing Manual
• NCCI (National Correct Coding Initiative)
• OIG (Office of Inspector General
• 1995 Documentation and Guidelines for Evaluation & Management Services
• 1997 Documentation and Guidelines for Evaluation & Management Services

For further information email your questions to [email protected] .

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