2025 CPT code 93304
Effective Date: N/A Medicine - Cardiovascular Procedures Feed
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study.
Modifiers 26 and TC can be applied, as described above.
Medical necessity should be established by documenting the specific clinical question being addressed by the limited echocardiogram and the patient's history of congenital heart disease. The documentation should demonstrate that the information obtained from the limited study is necessary for the patient's ongoing care.
The physician prepares the patient, applies gel, and positions the transducer on the chest. They obtain and interpret images of the heart, focusing on the known congenital anomaly, and document the findings in a report.
In simple words: A limited ultrasound of the heart is performed to check on a known heart problem that has been present since birth. This is a more focused exam and does not look at all parts of the heart in detail.
This code represents a follow-up or limited transthoracic echocardiogram specifically for patients with congenital heart defects.It is a focused exam and does not include a full evaluation of all heart structures as in a complete echocardiogram. The procedure involves obtaining ultrasonic images of the heart through the chest wall to assess specific clinical concerns related to the pre-existing congenital anomaly.
Example 1: A pediatric patient with a ventricular septal defect (VSD) has a follow-up echocardiogram to monitor the size of the defect and assess its impact on heart function., A young adult patient with a repaired tetralogy of Fallot has a limited echocardiogram to evaluate the function of the right ventricle and pulmonary valve., A child with a history of atrial septal defect (ASD) closure has a follow-up echocardiogram to assess for any residual shunting or complications.
Documentation should include the reason for the limited study, the specific structures examined, images obtained, measurements taken, and a clinical interpretation of the findings.Any limitations in visualizing structures should be noted.
- Modifier TC rule: Modifier TC is applicable if only the technical component is being billed, except when the hospital provides it.
- Specialties:Pediatric Cardiology, Congenital Cardiology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Independent Clinic, Mobile Unit