Ask Dr. Z

What are the appropriate Echocardiogram that should be billed for the following ICD-10 codes?Q21.1 (PFO) & Q23.1 (Bicuspid Aortic Valve) Should we bill CPT non-congenital Echocardiograms (93306-93308) or Congenital Echocardiograms (93303-93304)? The only documentation we were able to find is AMA CPT Assistant, May 2015, Volume 25, Issue 5, pages 10-11. Which states : Congenital echo codes should not be used when complex congenital heart disease is suspected but not found on echocardiographic evaluation or for “simple” congenital anomalies such as patent foramen ovale (PFO) or bicuspid aortic valve. Our Cardiologists disagree about Bicuspid Aortic Valve (Q23.1). They state we SHOULD bill congenital for Bicuspid Aortic Valve because it is by definition a congenital heart defect and will be followed by cardiology with serial echocardiograms over time even if they are asymptomatic. As for PFO (Q21.1) some of the Cardiologist considered it by definition a "congenital" heart defect, while other state we should not bill congenital for a PFO, it is a variant