Ask Dr. Z

In our facility, we frequently encounter patients who receive more than one echocardiogram on the same date of service. For example, patient presented for echo at 10:07 AM (CPT codes 93303, 93320, 93325 were documented and billed). Patient returns later that day (2:52 PM) and has a second echocardiogram performed (documentation supports 93304-XE, 93321, 93325). Knowing that 93325 has an MUE of 1, would you suggest that we append a modifier -76/-77, bypass the MUE, and submit documentation to support the second color flow charge? Assuming documentation would support separate encounters and/or medical necessity that is (i.e., change in patient clinical status). Or would you suggest reporting 93325 only once? We encounter the same issue when reporting fetal echocardiography on twins (76825 x 2, 76827 x 2, 93325 x 2). In twin fetal echo scenarios, color flow is being performed on two different fetal hearts; however, it’s all done during the same session. Does that warrant only one unit of 93325?