Can CPT 93306 and 93356 Be Billed Together?

Medical coding and billing for diagnostic procedures play a significant role in healthcare operations. Accurate coding ensures proper reimbursement for services rendered by healthcare providers. It also helps maintain compliance with various regulations set forth by government and private payers. The intricate system of Current Procedural Terminology (CPT) codes categorizes medical services and procedures, making it possible to standardize claims for payment.

Understanding CPT Codes 93306 and 93356

CPT code 93306 describes a complete transthoracic echocardiogram. This comprehensive study involves using ultrasound waves to create detailed images of the heart’s structure and function. Components typically included in a “complete” echocardiogram are two-dimensional (2D) imaging, M-mode recording, spectral Doppler, and color flow Doppler. The procedure assesses the heart’s chambers, valves, and surrounding vessels.

CPT code 93356 represents myocardial strain imaging using speckle tracking. This advanced technique quantitatively assesses myocardial mechanics, assessing heart muscle function. Unlike 93306, which is a standalone complete study, 93356 is an “add-on” code, meaning it must be reported in addition to a primary echocardiography code, such as 93306. While 93356 specifically focuses on myocardial strain, 93306 covers the broader, complete transthoracic echocardiogram.

Billing Guidance for Concurrent Echocardiography Codes

CPT code 93306 encompasses a complete transthoracic echocardiogram, which serves as the foundational study. CPT code 93356, representing myocardial strain imaging, is an add-on code that builds upon a base echocardiography service. Therefore, when myocardial strain imaging is performed, 93356 is billed in addition to a primary echocardiogram code like 93306, not as a completely separate and unbundled service. This means that while they appear on the same claim, 93356 is dependent on 93306 (or another primary echo code) being performed.

The National Correct Coding Initiative (NCCI) edits prevent inappropriate billing of code pairs. While 93356 is an add-on code to 93306, meaning they are intended to be billed together when strain imaging is performed, billing two separate complete echocardiograms (e.g., two instances of 93306) on the same day for the same patient is generally not permissible.

In rare circumstances, Modifier 59 (“Distinct Procedural Service”) may indicate two services, normally bundled, were performed for different clinical reasons, in separate sessions, or on different sites. For example, if two complete echocardiograms (e.g., two instances of 93306) were performed on the same day for truly distinct and unrelated clinical issues, and the documentation rigorously supports each as a separate and independent procedure, Modifier 59 could be appended to the second instance. However, this scenario is highly scrutinized by payers, and such claims are frequently denied unless the medical record provides exceptionally robust justification for two complete, distinct procedures. The use of Modifier 59 should be reserved for situations where no other, more specific modifier applies.

Documentation Requirements for Echocardiography Billing

Accurate medical documentation is essential for supporting any echocardiography billing, particularly when complex or potentially concurrent services are involved. The medical record must clearly demonstrate the medical necessity for the procedure, outlining the clinical indications that prompted the echocardiogram. This includes relevant patient history, physical examination findings, and the specific reasons for performing the study.

The documentation must also clearly indicate the type of study performed, detailing the findings, measurements, and interpretations. A formal written report with interpretation, signed by the interpreting physician, is a standard requirement. This report should include quantitative data, such as measurements of cardiac chambers and valve function, and a qualitative description of the heart’s function. If a modifier, such as Modifier 59, is used in an exceptional circumstance, the documentation must explicitly support the distinctness of the services to justify its use, providing a clear narrative for separate and identifiable procedures. Payers may request to review the medical record to verify the appropriate use of modifiers before processing claims.