When reviewing a medical bill, diagnostic procedures like an echocardiogram (“echo”) are itemized using five-digit codes. This standardized coding system bridges communication between medical providers and insurance companies, ensuring clarity across the complex healthcare landscape. An echo is a common heart imaging test that can appear under several different codes depending on how it was performed. This article explains the standardized codes associated with different heart imaging procedures to provide clarity about your medical bill.
The Function of CPT Codes in Healthcare
Healthcare systems in the United States rely on the Current Procedural Terminology (CPT) codes to describe medical services. Managed and copyrighted by the American Medical Association (AMA), these five-digit codes identify medical, surgical, and diagnostic services performed by healthcare professionals. The primary purpose of CPT codes is to streamline billing and reimbursement processes. When a provider submits a claim, the CPT code tells the insurer exactly what procedure was performed. Beyond payment, these codes are also used to track healthcare utilization and develop guidelines for medical care review.
Standard Codes for Echocardiogram Procedures
The term “echocardiogram” encompasses several types of ultrasound tests, each with a corresponding CPT code based on the specific technique and level of detail.
Transthoracic Echocardiography (TTE)
TTE is the most common type, where a transducer is moved across the chest wall to capture images of the heart. A complete TTE that includes spectral and color Doppler imaging, which assesses the heart’s structure, function, and blood flow, is reported with CPT code 93306. If the study is complete but specifically excludes the spectral and color Doppler components, meaning it does not evaluate blood flow patterns, code 93307 is used. A more focused study, such as a limited or follow-up TTE, is typically coded as 93308 when fewer than the required nine cardiac structures are documented.
Transesophageal Echocardiography (TEE)
TEE is a more invasive approach, involving inserting a probe down the esophagus to position the transducer closer to the heart for clearer images. The comprehensive TEE service, which includes probe placement, image acquisition, interpretation, and the final report, is billed using CPT code 93312. If the procedure is split between two providers, CPT code 93313 covers only the probe placement, while 93314 covers the interpretation and report.
Stress Echocardiography
Stress Echocardiography assesses heart function under physical or pharmacological stress. Code 93351 describes a complete stress echo service, combining imaging at rest and during stress with continuous electrocardiographic (ECG) monitoring, physician supervision, and interpretation. If the echocardiographic imaging portion is billed separately from the stress test components, CPT code 93350 is used, covering only the imaging and interpretation without the continuous ECG monitoring.
Variables That Determine the Final Code Selection
The final code selection for an echocardiogram is often complicated by the need to separate the service into two distinct parts for billing purposes. Diagnostic procedures typically include a professional component and a technical component. The technical component covers the use of the equipment, supplies, and the work of the technician who performs the test, and this is usually billed by the facility or hospital.
The professional component covers the physician’s work, which includes the supervision of the test, the interpretation of the images, and the generation of a written report. When these components are billed separately, the technical component is indicated by adding the modifier “-TC” to the base CPT code, and the professional component is indicated by adding the modifier “-26”. This separation explains why a single echocardiogram may result in two line items on a bill, one from the facility and one from the interpreting cardiologist.
Additional technologies used during the test require specific add-on CPT codes reported alongside the primary procedure code:
- If an echocardiographic contrast agent is administered to enhance image clarity, the add-on code +93352 is used.
- Advanced imaging techniques like 3D echocardiography may be reported with codes 76376 or 76377, depending on whether post-processing was performed on the echo machine or an independent workstation.
The setting where the service is performed, such as an outpatient clinic versus a hospital inpatient setting, can also influence whether the service is billed as a single global code or split into its professional and technical components.