Good afternoon, everybody, we're going to give it just about another minute and let folks get dialed into the webcast today. Good afternoon. If you're just joining us, we're going to give it just a couple more seconds and let folks get dialed into the webinar. All right we'll go ahead and get started. All right good afternoon everybody. Thank you for joining us today. At the end of last year we went through our webinar surveys that are sent out post webcasts and saw that almost every one of them had requests for congenital so we are happy to provide you with a two-part congenital series this month actually. Today we're going to cover the non-invasive diagnostic services but in I think about three weeks we're going to cover some of the cath lab based services so we'll you know discuss those details in the second series. So just a quick introduction my name is Jamie Quimby. I'm the director of coding with our revenue cycle team and happy to be joining with you today. So we will start with some housekeeping. So if you need to access the slides there is a separate link that's sent out where you can access it and download a pdf copy. We do also upload the pdf copy onto our Medaxium academy platform so if you're having difficulties uploading it from the link that is being posted feel free post webcast to get a copy from there. If you have any questions please submit your specific questions in the Q&A box. Please remember to keep your questions on topic. For CODI CEU certificates for the AAPC those are actually able to be downloaded now in your Medaxium academy account. So you would click on to the specific webcast and there's a way for you to download it and you can literally drag and copy that pdf into your desktop or however you like to save them. Whether that you know you prefer to print it or you know whatever your preference is and then it does make it easy to upload your CEU certificate now within the AAPC platform. As far as AHIMA goes if you are credentialed with AHIMA I also hold a credential with them. I know they're going to be changing their rules with their CEU certificates. I think right now it's on pause. I was doing some research a few days ago on it so right now they are still accepting the AAPC because I did upload a couple myself but I think their ultimate goal is to go to 40 percent that have to come directly from them. So you still will have the opportunity to upload AAPC approved ones to them if you do hold that credential. Do give at least one to two business days for our team to get your certificate uploaded to your account. And again this is just a screenshot of how you would download it so you can see you would go into that specific webcast and then there is a way for you to claim that CEU and once you claim that another box will pop up where you can either download it or print it. All right so we're going to start with covering the anatomy of congenital heart defects. You know as a coder it's very important for you to understand just the anatomy in general of any area of the cardiovascular cardiovascular world that you are coding for. It helps you understand the condition and how clinicians do ultimately treat those conditions. So what is congenital heart disease? This is it's the most common type of birth defects and a lot of if you go to the CDC website they actually have some excellent resources. Very detailed they give you statistics and all kinds of they break down the conditions define them so it's an excellent resource if you're ever wanting to learn more. But again there have been multiple studies over the years that show the approximate numbers of yearly reported defects and like I said the current data from CDC estimates about one percent of births or about 40,000 babies a year are born with these conditions. So congenital heart defects are present at birth and can affect the structure of a baby's heart and the way it works. They can affect how the blood flows through the heart and out through the rest of the body. The congenital heart defects can vary from being mild such as a small hole in the heart to severe meaning there are you know parts of the heart that are poorly formed or even missing. So some congenital heart defects may be diagnosed during pregnancy but some however are not detected until after birth or sometimes even later in life. So again treatment for those is going to depend on the type and the severity of the defect. All right so looking at the normal anatomy of the heart. So just looking at it normal heart is a strong hard working pump that is made of muscle tissue. It's about the size of a person's fist. On the right side of the heart you have the right atrium and the right ventricle and those work to pump oxygen or blood returning from the body back to the lungs to be re-oxygenated. On the left side of the heart you have the left atrium and the left ventricle combined to pump oxygenated blood back through the body. So congenital defects may involve a valve, a chamber, the septum, an artery, or blood flow issues. So we're going to cover what some of those conditions are. It's not an all-inclusive list. There are several. We're going to cover several today but just so you know there are some more that you can actually find information for on the CDC website. So with the atrial septal defect this is a birth defect in the heart in which there is a hole in the wall or the septum that divides the upper chambers meaning the atrium of the heart. The hole can vary in size and it may close on its own or ultimately the patient may require surgery. So the current CDC numbers estimate that 13 of every 10,000 babies are born with this atrial septal defect. So when they break it down even smaller they say one in every 770 babies are born with this each year. Atrioventricular septal defect and this was something that I saw was added from the last time I had checked their site. So again they're always updating it which I definitely was pleasantly surprised to see. I even noticed that the statistical numbers had been updated so from the last time I had looked. So this condition occurs when the holes between the chambers of the right and left side of the heart. The condition is also again called atrioventricular canal defect and people that have this the valve that controls the blood flow between these chambers may not form correctly and it's estimated that one in 1,712 babies in the United States are born with this condition each year. All right so coarctation of the aorta. This is a birth defect in which part of the aorta is narrower than usual. The narrowing blocks normal blood flow to the body. This can back up flow into that left ventricle chamber of the heart which then makes the muscles in that chamber work harder to get blood out of the heart. And this number they estimate again one in about every 1,712 babies are also born with this condition each year. So again it does also state in their data that sometimes this condition occurs with other congenital heart defects also. All right so DTGA happens when the main pulmonary artery and the aorta are switched in position or transposed. The main pulmonary artery and the aorta are the two main arteries that carry blood out of the heart. So with this condition it says the oxygen poor blood from the body enters the right side of the heart but instead of going to the lungs the blood is pumped back out of the body through the aorta. So oxygen rich blood from the lungs entering the heart is pumped straight back to the lungs through the main pulmonary artery. So again data does show that babies with this condition often also have other heart defects. It shows most commonly they may have a ventricular septal defect or an atrial septal defect. And this estimate they state in the data that about one in every 3,957 babies are born with this condition. And that overall estimate with the yearly birth rates they're saying about 928 babies a year in the United States are born with this condition. All right hypoplastic left heart syndrome or HLHS. This is a birth defect that affects normal blood flow through the heart because the baby with this defect needs surgery or other procedures soon after birth. This is considered a critical congenital heart defect. So there's certain conditions that they define as a critical congenital heart defect and this is definitely one of them. Hypoplastic left heart syndrome affects the number of structures on the left side of the heart that do not fully develop. So for example with this the left ventricle may be underdeveloped and too small. The mitral and aortic valves may also either not form or they're very small. The ascending portion of the aorta could be underdeveloped or also too small. And then it also states that babies with this condition also also have an atrial septal defect. So the estimate with this condition is about one out of every 3,955 babies or overall estimate for each year it's stating about 929 babies a year are born with this condition. All right so PDA. This is an unclosed hole in the aorta. Every baby is born with a ductus arteriosus. After birth the opening is no longer needed and usually narrows and closes within the first few days but sometimes that does not close after birth. So failure of the ductus closing is common in premature infants but rare in full-term babies. All right so pulmonary atresia. This is a birth defect of the heart where the valve that controls the blood flow from the heart to the lungs doesn't form at all. In babies with this defect blood has trouble flowing to the lungs to pick up oxygen for the body. There are typically two types of this condition. The first type is pulmonary atresia with an intact ventricular septum and then the other type is pulmonary atresia with ventricular septal defect. So again two different ways you could code that just depending on the physician's assessment. So again let's go down. So one in about every 6,708 babies in the United States is born with this. So estimates per year is about 548 babies. All right TOF. So this is a condition caused by a combination of four heart defects that are present at birth. The four abnormalities that make up this defect include that pulmonary valve stenosis, a ventricular septal defect, an overriding aorta, and a right ventricular hypertrophy. So again it's a combination of four abnormalities and it does estimate about one in every 2,077 babies in the United States are born with this condition. All right so total anomalous pulmonary venous return. This was another new one I saw added to the CDC site. So I was happy you know like I said that there's constant updates happening, new education out there for you know provided for our community. So this is when the pulmonary veins bringing blood back from the lungs do not connect to that left atrium. Instead they go to the heart by the way of an abnormal or anomalous connection. In a baby with this condition oxygen rich blood from the lungs returns to the right side of the heart. Here oxygen rich blood mixes with oxygen poor blood. This causes the baby to get less oxygen than needed to the body. And it is estimated that one in every 7,809 babies in the United States are born with this or an overall number of 504 babies per year in the United States. All right tricuspid atresia occurs when the tricuspid valve in the heart does not form at all. The tricuspid valve controls blood flow from the right atrium to that right ventricle. The right atrium again is in that upper chamber and the right ventricle again is in that lower chamber. So with this condition blood can't flow correctly through the heart into the rest of the body. So again blood is unable to get from the right atrium through that right ventricle and out to the lungs. And for this reason the right ventricle can also be underdeveloped. The main pulmonary artery may also be small with very little blood going through it to the lungs also. And again this is another condition that is also considered a critical congenital heart defect. It is estimated about one in every 11,309 babies are born with this or overall yearly number would be 325 estimate in the United States each year. All right so in babies with this condition oxygen poor blood and oxygen rich blood are mixed together as blood flows to the lungs and the rest of the body. As a result too much blood goes to the lungs and the heart works harder to pump blood to the rest of the body. And also instead of having both an aortic valve and a pulmonary valve babies with this condition have a single common valve controlling blood flow out of the heart. It is estimated that one out of every 15,984 have this condition at birth or an overall number of 230 cases a year in the United States. All right and I think this is our last one we'll cover. Again there if you want you know I highly recommend going to the CDC website if you do work in the congenital area. They have all kinds of resources on there so it's an excellent resource for us. So lastly we'll cover the ventricular septal defect. This is a defect in the heart where there's a hole in the septum that's separating the two lower chambers of the heart. So again a baby born with this condition can have one or more holes in different places of the septum. There are several names for these holes you know and different diagnosis codes that you can assign to them now too just depending on that specificity that you have. About 42 in every 10,000 babies are born with this condition each year. Okay so we're going to cover some basic guidelines coming up next just for overall diagnostic services because that is what we are ultimately going to cover today. So before I get started on covering with this slide I know in our congenital world we don't deal with Medicare often but saying that they do however set a lot of the standards for the guidelines that a lot of the big payers do typically follow. And you know as I was putting this information together I was like you know wanting to just look at some specific carrier guidance. And I looked at several but a lot of them did fall in line with this exact language that Medicare also puts out there in the guidance. So again I know in congenital we don't typically follow Medicare rules because we are not billing a lot of Medicare patients but again a lot of what they put out there kind of sets the standard. So again check with any specific carriers that you deal with. You know if you have a big patient population with certain carriers I would just check and see what kind of information and guidance they may have. But from what I found you know just doing some digging around and looking at some specific websites for other commercial carriers I did find a lot of this aligns. So just covering that so remember diagnostic studies you know have to have an order so that is a requirement. So again the test must be ordered by the physician or the non-physician practitioner who is treating the patient for a specific medical problem and who uses those results to manage and treat that problem. Tests ordered by someone else not actively involved in the patient's care are not generally considered medically necessary. So again keep that in mind. We don't typically have that issue in our specialty but that was language that I did see printed within some guidelines. So again just make sure there is an active order from your clinician or non-physician practitioner that is treating that patient. Again medical necessity has to be supported so document the intent for the order. What symptoms do they have? Do they have a definitive diagnosis already? Do they have that definitive diagnosis but they're having new symptoms like what is the intent for the order? What is you know supporting that medical necessity for even ordering the service? Again I know with Medicare we have national coverage determination along with some of the local but a lot of your carrier specific commercial payers do also have you know regulations and medical necessity guidelines for certain services. So you definitely want to check those and then check any authorization requirements too. A lot of our diagnostic services you know depending on the carrier may have authorization requirements in place before you even perform the service. So you definitely want to make sure you're staying up to date on that. All right so supervision guidelines. Again a lot of this aligned with some of the commercial payers that I looked at their guidance on. So again so looking at Medicare along with what I found with a lot of the commercial payers across the country. So general supervision means that the procedure is furnished under the physician's overall direction and control but their presence is not required during the performance. Direct supervision means the physician must be present in the office suite and immediately available but they do not have to be physically present in the room where the service is being provided. Personal supervision means the physician must be in attendance in the room during the performance of the procedure. So again you can find a lot of that detail within your carrier specific guidance on what their supervision requirements are. So again I'll pick on Blue Cross for a second because I did look at them also. So they, in their policy for non-invasive testing, they did say that the provider, the service must be performed by or under the direct personal supervision of a qualified provider. So again, they don't have to necessarily be in the room during the service, but they do need to be available in case, you know, something arises and they need to go into the room. All right, did I skip? Okay, sorry, I thought I skipped over. All right, so of course some of our services do require, depending on the place of service they're being provided in and whether or not the practice itself owns that equipment. So you may be looking at a professional component or a technical component. If you're in a group where you provide services within your own office setting and you own that equipment, you would just report that full global service without a modifier. But again, if you're like in a hospital setting and let's say you're just providing an echocardiogram, you will need to provide that professional modifier to the service and then the hospital would report that technical modifier. So when looking at that professional technical aspect, there are differences between them. So again, for the professional component only, these items represent the physician work or the, again, that professional component. It would also include the interpretation of that service that was rendered within that physician report. Technical component, again, that's going to be any administrative, personnel, facility, equipment costs, and then they would append that modifier TC for that technical component. So just overall tips to answer some like what the medical necessity. So again, why is the service needed? What is the intent? Why is it being ordered? What services are being performed and ordered? Does the reason for the service meet any local coverage guidelines, whether it be national or your local specific carrier guidance? A lot of those guidelines have very detailed information in there, so highly recommend you review those yearly because they do update them. And then how, who, and where will the service be performed? You know, are you going to perform it in-house with your own equipment? Are you going to refer them out to, you know, a hospital setting as an outpatient? Those types of things. And do you have an accurate, appropriate order and the documentation to support the service was performed? So again, all those kind of help fall in line with the whole revenue cycle piece of things to ultimately get your claim processed and paid by your carrier. All right, so now we're going to cover some actual common congenital diagnostic services. We're going to start with echocardiography. We're going to be on this for several slides because there's all kinds of services available. We're going to start with a fetal echocardiography. So again, this is real time with or without in-mode recording. Real-time scanning displays both 2D structure images and movement with time. The in-mode is a single-dimension method of recording and velocity of a moving structure that produces the echo study itself. So again, it's just going to depend on the level of detail and whether, you know, you have a complete study or a follow-up. Is that spectral display also included or not? You know, are they also evaluating the umbilical core or the artery, the middle cerebral artery? So varying coding options just depending on what you are performing. CPT Assistant did release an article back in September of 2017 that defines what a complete fetal echo is and what would be required in that documentation. So again, imaging of the fetus to identify fetal orientation and the fetal cephalic caudal ends, the extremities, and the spine. Determination of the fetal sinus. Evaluations of all parts of the heart, including any venous connections, chambers, competence, and movement of the valves and the great arterial connections. And then again, lastly, evaluation of cardiac function with that in mode. And then and or spectral doppler when indicated. So again, these are from a CPT Assistant article and this is what defines what a complete fetal echo would be. All right, with just our standard transthoracic echo, different reporting options depending on what the medical necessity for it and then what the ultimate findings are. So in you know our traditional adult cardiology where congenital is not you know as common, typically we're reporting you know the 933-06, 07, or that 08. The 933-03 and the 04 are specific for congenital cardiac anomalies. I'll cover some CPT Assistant articles that will definitely be helpful when you're coding these services. But just keep in mind if it's not, let's say you a child was referred for a murmur being heard and they do a full complete echocardiogram at that visit and they determine that it was an innocent murmur and you know there's no issues and follow-up kind of as needed. That would not be coded for even though they went to a congenital cardiologist for that because of due to the patient's age, you know you're going to report that as a regular transthoracic echo, wouldn't be a congenital one. So again, depending on your conditions and what the ultimate findings are was going to vary based off of your coding there. Let's define what a complete echo versus that limited and as how they're defined by the AMA or CPT. So 2D, M mode when performed, that left and right atrium, the left and right ventricles, the aortic, the mitral, and the tricuspid valves, that pericardium, and again the adjacent portions of the aorta. All this information is printed guidelines within your coding book. But let's say you do have a patient that does have congenital anomalies. There may be, you know, depending on the severity of their conditions that they have, they may not have some of these components. So when I was doing some, you know, research from the CPT assistant, I did find language where they did state it would still be classified as a complete study. So let's just say, for example, they had a non-developed left ventricle or maybe there was a very little left ventricle there to even evaluate. As long as the other areas of the heart are evaluated and studied, it would still qualify as a complete study. So again, when you're looking in your CPT book under the guidelines before the echo coding starts, you're going to see all this language. They reference this language in regards to the 9-3-3-0-6 code. But again, CPT assistant does state for the congenitals, as long as everything that can be evaluated is that falls in line with this guidelines, then you would still code it as a complete study. Additional structures that you might also evaluate, but they're not part of the requirement for a complete study, would be the pulmonary artery, the pulmonary veins, or the pulmonary valve. Also the IVC, that can also be included as part of the service, but it's not a requirement for a complete study. Okay, so transesophageal echo. So these are mostly done in a facility setting, of course. Usually the patient's sedated, but this is where they put a probe down the patient's esophagus and then get images from the heart that way. Different coding options, again, just depending on your indications and what the ultimate findings are. So again, if you don't have any congenital anomalies that are present, then you're just going to code the traditional TEEs. And then if you do have congenital anomalies, then you would code the 93315 if you're also placing the probe. Sometimes an anesthesiologist might do the actual probe placement. So if you're just doing the professional piece of the service, you would just report the 93317, which is the image acquisition along with that interpretation report, or the 93314 if it's non-congenital. Structural heart TEE. We'll kind of cover this more in the next webcast series, but I did want to briefly touch up on this. This is done in conjunction with a structural heart procedure. The big thing to point out here is that it cannot be performed by the same provider that is performing the structural heart procedure itself. It has to be a separate physician. So, you know, you'll hear us cover this again in a couple weeks when we meet again. But just to point out, this is also a TEE. It's just done in guidance along with a structural procedure that may be performed, whether, you know, they're doing something with the pulmonary valve or the atrial, you know, whatever the case, the procedure is itself, if it qualifies under here. It does include probe manipulation. It also includes any 3D imaging. So we did get some 3D, we got a new 3D code a couple years ago with TEEs that you can report or with your standard congenital echo codes. So if 3D is also done with this code, it is part of the description and not separately reportable. All right. I get the most questions with echo services with the Dopplers. So we're going to cover these in detail in the next couple slides. So a complete Doppler is one that examines every cardiac valve and the atrial and ventricular septa for that anti-grade or retrograde flow, according to the intersocietal commission for the accreditation of echocardiography or what they commonly call the ICAEL. They do set the standards or one of the, there's a society for the echocardiography services. So they have some really good information on their website as far as what requirements are needed, depending on the type of service being provided. Color flow studies currently do not have a complete and limited option. So if color flow is provided, whether it be to just one specific valve or multiple, there's no difference in coding with that. You would just code the 93325 for that service. So a lot of questions I get though, is how do you know the difference between the spectral Doppler and that color flow Doppler? I get a common argument from coding, some coders that, you know, if regurgitation findings are documented, that means color flow was done. That's not necessarily true. And you'll see in the breakdown of documentation points, you can also get regurgitation findings in the spectral Doppler. So that spectral Doppler is broken up into two areas. We have the continuous wave, and then we also have the pulse wave. So you're going to see those referenced a lot in an echo report. So there's two areas to a spectral Doppler. And in that pulse wave, you can also get regurgitation findings. So if, you know, you ever hear that, you know, if there's regurgitation, it means color flow. It's not necessarily true. It's really up to the, you know, the provider that's doing the interpretation of the study, along with going to your echo tech and just asking them what techniques. It's always best if they document the techniques that they are using within the study itself. And a lot of times they do. Sometimes where we see the documentation lack would be in a limited or follow-up study. Sometimes they don't always reference the study. Sometimes they don't always reference that the Doppler and color flow Doppler are being utilized. So again, just if you're not sure, I would reach out, you know, to both either the provider and the echo tech and just have that clarified. All right. So with the services we're covering today in general, so I went to our MedAccess team and asked them to send me the data of the CPT codes that our congenital practices are submitting the data to us for. So when I started looking at all the testing services, the myocardial strain, there's going to be several things we cover today. And all of these were actually within that data from our, you know, pediatric congenital members where you are actually reporting all of these services. So again, this was another area. We see this a lot in, you know, adult cardiology or non-congenital cardiology where the myocardial strain imaging is also being utilized, but it's definitely being utilized in our congenital world as well. So when you're looking at the myocardial strain imaging, sometimes it's referred to, you know, just as that strain imaging. Sometimes it's abbreviated with GLS. Again, it's all the same thing. The service is giving you findings in that left ventricle chamber, and they're looking for, you know, any further details of deformation or if there's any blocks that may contain like abnormal patterns to assess that chamber itself. So again, there is no modifier 26 or TC that are applicable with this service. So again, whether you're doing this service in your office setting or where you own that equipment or you're doing it in a hospital setting, you're just reporting the code as it is. There is no professional technical piece to it. So again, your findings are always going to be within that left ventricle chamber if they do provide this service. It is allowed to be added on, again, with your congenital echoes, your standard echoes, or a stress echo. This was a CPT assistant from July of 2020. So they asked if the myocardial strain imaging using spectral tracking derived assessment of the myocardial assessments, and what they clarified is, so if it's done multiple times, what they're saying here is you can only report it once. So there are occasions where a traditional echo and a stress echo might be done same day. So if you're doing it with each session, you can only report it one time. So keep that in mind. All right, so 3D echoes. This is a common one. So in the congenital world, you're probably reporting this code more frequently than the 7000 series. This code was specifically created for a 3D echocardiogram for congenital cardiac anomalies. They do list out the CPTs that it is applicable to. One coding note to point out, most carriers, if you are also reporting the color flow doppler separately, meaning, you know, if you're doing a TEE, and they also do the spectral color flow doppler, those are add-on to this, you know, along with your congenitals, but you cannot report this 93325 with the 3D imaging. Most carriers are denying when you're doing the 3D imaging. Most carriers are denying when you report both together. Now, if you're, you know, you're not falling within the cardiac anomalies, and you do a standard echo within the office setting, and you're reporting that 93306 for that complete echo, and you still provide the 3D imaging, you're going to have to go to the 7000 series in that case. So the coding differs depending on whether or not you have that independent workstation, and it's really up to the clinicians and the echo techs to document that level of detail. If, as coders, if we're looking at a note, and we don't see that level of detail, which I can tell you more commonly than not, I never see that level of detail in an echo report, you're going to have to code it without the 3D or the independent workstation, because I don't know without them telling me if that is the case or not. So this code does have the 26TC modifier applicable to it, so if you're doing this in a hospital facility setting where you don't own that equipment, just make sure you're appending the appropriate modifiers. Coverage for the 3D with the 7000 codes, just to point out, sometimes can be difficult depending on the payer. Sometimes they want a specific diagnosis. If the echo was truly abnormal, they will require that abnormal cardiovascular study diagnosis to be reported in order for them to pay that 3D. So carriers definitely vary. That is a common one that we have seen across the country with some of the payers though. So bubble study, this one's kind of interesting. So normally carriers don't reimburse anything extra for a saline. There are specific HCPCS codes, they start with the J, that are available just depending, you know, what that saline would fall under for how it's defined by the specific code. But interesting enough, in the past we've never seen these reimbursed, but we do work with a couple programs now and saw that the J codes are being reported with this bubble studies, because really all they're doing during the study is injecting saline and then getting images from that with the echo. And I actually saw some claims that were paid in process, so I don't want to tell you, you know, in this right here, it's just going to vary on the payer. So if you try to bill for the saline and you get a denial, then that's pretty standard in what we've seen over the years. But like I said, we have a couple of programs that we work with now that they have tried to report the saline because they are truly providing it and they were reimbursed. It's definitely not a lot, but if you find you're going to get reimbursed for it, then definitely try for it. If you see you're, you know, trending and they're all denying, then you would just report the echo service that you're providing. Sometimes with these, they're just a limited study. They're not a complete, but again, does not say that a complete study couldn't be performed. Definity study. I did see this on some of the data submitted. So this is when you're doing, you own your equipment and doing it. If you're doing this in the hospital setting, the hospital is actually going to be the entity that is billing for the Definity itself. But if you are doing it in your own office setting, and again, you own everything, you can report this additional Q code. Some of the carriers have gone to requiring that JW or JZ modifier. So you're defining whether or not you used all the agent or if there was some leftover. So again, just check with those specific carriers. If you are reporting the service and you're starting to see a denial trend where they're wanting one of those two modifiers, you also, if you are reporting this, they're going to want, you know, the units used, they usually do it per milliliter. And then sometimes they also require that NCD number and DC number on the claim as well. Okay. So stress echo, we have different reporting options, just depending again, you know, if you're doing it in your own office setting, facility setting, or if you have multiple providers involved, the 93351 would include the physician supervision with that stress. So you would not report the 93351 in conjunction with your stress testing codes, because it includes all of it. If you're doing it in a facility setting and you have, you know, physician A is doing the actual supervision while they're stressing the patient and then physician B is the one doing the actual interpretation, that's where some of the coding might get split up because you're going to build the 93016 for the supervision to provider A and then provider B would get the 93018 for the interpretation and then again that you would build the 93350 with the 26 with that physician interpretation also. There is another code that you can add on if you use a contrast agent during the stress so that 93352 is an add-on code to either the 93350 or that 51 depending on what your services support. So to cover some CPT assistant articles related to our traditional ECHOs, in this question it says CPT codes 93303 and 04 were developed, you know, to show the different services involved in assessing and performing echocardiography on infants and children with those congenital cardiac anomalies. Are there exceptions to the list of the congenital cardiac anomalies specifically for a PFO or that bicuspid aortic valve? That should be considered when choosing which congenital ECHO to report. So what CPT assistant came back and said, and if you code congenital cardiac CAFs right now you already know this guidelines for the CAFs because this is specifically printed in the book and again we'll cover this in a couple weeks when we meet again, but they specifically call out certain congenital conditions and state that those should not be coded as a congenital. So again, and what they specifically state here for the ECHOs is if there is a congenital anomaly such as a PFO or that bicuspid aortic valve, those cases should be reported with the non-congenital ECHO codes. So again, that's why I was saying earlier, just depending on what the intent is and what the ultimate findings are from that physician interpretation could vary what ECHO code you can actually report. So again, if they have a PFO or that bicuspid aortic valve and no other congenital anomalies are present, then you have to code the standard ECHO services. So another CPT assistant, this was from April of 2022, was asked for the purpose of congenital echocardiograms, meaning a traditional or a TEE, if the patient is status post heart transplant and no residual congenital anomalies exist, is it appropriate to report a non-congenital study? So this also aligns with our congenital CAF reporting. So once the heart transplant has happened and the patient's being seen post transplant and there's no residual congenital anomalies present anymore, you would code those as non-congenital. So it's the same with the ECHOs from, and this is from CPT assistant again. Okay, so we're going to cover some MRI services now for the heart. So a cardiac MRI differs from a traditional MRI in its ability to provide a psychological evaluation of the cardiac function. It acquires information about the heart as it's beating and creates moving images of the heart throughout its pumping cycle. So what is an MRI? It's a radiation-free non-invasive technique that produces high quality sectional images of the inside of the body in multiple planes. The MRI uses natural magnetic properties of the hydrogen atoms in our body that emit those radio frequency signals when exposed to those radio waves within a strong electromagnetic field. These signals are processed and converted by the computer into a high resolution 3D image. Patients with metallic or electronic implants or foreign bodies cannot be exposed to the MRI. And if you code any within the EP world, whether it be for congenital or non-congenital, you definitely see this a lot in documentation from the physicians if they are ordering an MRI study, you know, does the patient have a device implant? Is it MRI compatible? If not, then they cannot have the study done. So the patients must also remain still while lying on the table. So sometimes they might have to add a sedative agent, you know, to keep the patient calm and comfortable during the service. These codes here on the slide report for an exam of the chest. So the 71550 is if no contrast is used. The 5-1 is performed with contrast. And then that 5-2 is going to be with and without contrast. So again, that would be a combination of both if they are both done. So these are our cardiac MRI services. And again, so with the imaging done here is performed by obtaining the tomographic cuts from the base to the apex and or the interior to the posterior in order to interrogate the entire heart. Function studies may include observation of the atrium and the ventricles. They're going to get the qualitative and quantitative assessment of the ventricular function. And they're also obtaining numerical values of the ejection fraction, ventricular volumes, ventricular mass, and cardiac output. So you definitely get a lot more details with the cardiac MRI. So with the 75557, this is for observation of the cardiac function and morphology without administration of a contrast agent. Excuse me. The 5-9 is where it includes stress imaging. And then when you get to the 6-1, again, this is imaging for the morphology and function without contrast materials followed by contrast. So this is with and without. Your 6-3 is with and without contrast materials, but also includes your stress imaging. And then lastly, the 75565 is an add-on code to any of these if supported by your documentation. And this will record your velocity flow mapping. So this is an additional code you can report. It cannot be reported by itself, though. So it does have that plus in front of it. So it has to have a separate primary procedure. So just some guidelines to share. Only one procedure per session should be reported on your claim. You can't report multiple cardiac MRIs on the same claim. You would report the more intensive one. And again, that add-on code for the velocity flow can also be reported. Report 7559 with the 75565, again, if that flow with pharmacological wall motion stress evaluation without contrast is also done. And then if you are doing the stress portion with it, remember, depending on where the service is being provided, if it's in your own facility or a hospital facility, you can also report the stress testing codes itself. The 93015 is the global code, so that includes everything. If you're only doing it in a hospital setting, if you're providing the direct supervision and then the interpretation, that's when you're going to break it out into those component codes. All right, so now we're going to talk about some CT studies. So CT directs multiple narrow beams of x-rays around the body structure being studied and uses computer images to produce thin cross-sectional views of various layers or slices of the body. And these are pretty interesting to look at. I've seen some myself, you know, when, you know, just coding these services. And, you know, you do literally see the slices in the images. Patients are required to remain motionless during the study. And again, they may have to require a sedation to keep them calm. Cardiac CT is used, though, to evaluate the heart muscle, the coronary arteries, the pulmonary veins, the thoracic aorta, and the pericardium. So these codes here report a diagnostic exam of the thorax. So the 71250 is if no contrast is used. That 60 is performed with contrast. And again, the 70 is with and without contrast. All right, so now let's break up our heart CTs. So the 75571, this reports the CT of the heart and the quantitative evaluation of calcium deposits in the coronary tree. High levels of the calcium deposits in the heart triple a person's likelihood of suffering an adverse coronary event. In code 75572, this does include 3D image post-processing, assessment of the cardiac function, and evaluation of venous structures if performed. Probably in congenital world, you might be more, you know, reporting more of this next code, the 75573. So this is a CT of the heart with congenital anomalies, also performed utilizing contrast materials to evaluate that cardiac structure. This code also includes 3D imaging, post-processing, assessment of the left ventricle cardiac function, the right ventricle structure and function, and then evaluation of any vascular structures if performed. With the 75574, this is a CTA of the heart. So they do this to evaluate the heart, the coronary arteries, and any bypass graphs that are present. It also includes 3D imaging, any evaluation of the cardiac structure, assessment of that cardiac function, and again, evaluation of any venous structures if performed. Cardiac CT and that coronary CTA guidelines, they do include the axial source images of the pre-contrast arterial phase sequence and venous phase sequence if performed, as well as that 2D or 3D reformatted images resulting from the study. Each contrast enhanced CT and CTA code includes a conventional quantitative assessment, meaning the coronary percentage stenosis, ventricular volume, that ejection fraction, and stroke volume when performed. You would only report one CT heart service per encounter, so you would report the more intensive service. All right. So now we're going to look at some lung testing. So the first one's going to be the spirometry. This is a pulmonary function test that measures how much air you can breathe in and out of your lungs and how quickly you can blow it out. If you have asthma, as I do, you know this test is no fun, and you almost want to pass out when you're to the end where you have no more air in your body to push into this little machine. So it does help assess the lung function and can be used to diagnose and monitor various respiratory conditions, again, such as asthma, COPD, or any other lung diseases. There's different coding options just depending on what's being performed and all that. So with the 94010, this is used to measure functions of the lungs, including the amount of air contained in the lungs, the rate of expiration, and the volume of air as the patient pushes it out. The physician would interpret the results, and then they would document that recording that was obtained. The 94011 and the 94012, this is done in patients that are two years of age or younger. It measures and records the volume of inhaled and exhaled air and is used to assess the pulmonary function. So again, it's only done on patients two years or younger. Those two codes apply to that. So again, just depending on the level of detail that you have based off of the study, you know, would determine which one you report. With the 94013, this is also in children two years age of younger. And with this test, it does the measurements of the lung volumes in children. The measurements are useful in the evaluation of patients with respiratory symptoms and are typically limited to periods of sleep. So that maneuvers such as a face mask positioning, short occlusions of the airway, and application of an inflatable jacket can be more easily tolerated. Functional residual capacity, or FRC, refers to the volume of the air contained in the lung as it's expiring the air out. Forced vital capacity, or the FVC, measures the total volume of the air that's exhaled and pushed out in the amount of the additional air that can be exhaled following just normal expiration. And again, this code includes laboratory procedures and interpretation of test results. With the last three codes here, this one's done like in a 30-day period. So kind of like how some of our abnormal heart rhythm monitoring periods go, this is one that can be done for respiratory issues. So this range of codes is, again, used to report a patient-initiated recording up to a 30-day period. You would report the 94014 when the procedure includes teaching the patient how to use the spirometer, recording the volume of air exhaled and inhaled, analyzing the data, recalibrating the unit, and a physician or other qualified health care provider doing an analysis of that pulmonary function. With the 94015, this, again, is involved with the recording of the data, the hookup, continued education, data transmission and capture, any trending analysis, and the periodic recalibration without the provider's analysis of the pulmonary function. And then the 94016 is just the provider review and interpretation of that information only. Just some coding guidelines that we saw in the CPT AMA coding book. So it does exclude any separate identifiable E&M services. It also excludes some of the other pulmonary testing. So again, it's just going to depend what service was ultimately provided to the patient on that day, and then whether or not you're going to possibly need a modifier 25 on your E&M service or not. So it would just vary. Pulmonary stress tests. So sometimes we see this in our non-congenital world with the 94618. But definitely, again, with the data we received, we see our congenital patients doing this also. So in the 94618, a pulmonary exercise stress test is performed to determine how much air is moving in and out of the lungs during exercise and to establish where breathing problems are occurring, since it may be in the lungs, the heart, or the circulation. An exercise stress test is done when a patient's either riding a stationary bike or they might be walking on a treadmill. The heart rate, the breathing, and the blood pressures are monitored before beginning the exercise. Basic ventilation studies are performed with that spirometer and recording device as the patient breathes through a mouthpiece and connecting tube while a nose clip might prevent the nasal breathing itself. So that way, they're pushing all the air out of their mouth. Measurements of the patient's oxygen level by pulse oximetry is included, as well as oxygen titration and heart rate when performed. So in the 94621, cardiopulmonary exercise testing is performed. So here, electrodes are placed on the upper part of the body to monitor that heart. Throughout the process, they have blood samples maybe taken to measure the oxygen uptake and carbon dioxide waste products in the blood, as well as other tests, you know, including an EKG might also be done with it. All right, so we're also going to cover oxygen updates. So an oxygen update test, also known as a VO2 max test, measures the maximum amount of oxygen your body can absorb and use during exercise. Code 94680 applies to collecting expired air and evaluating oxygen uptake using direct methods during rest and exercise. The 94681 applies to collecting expired air and evaluating oxygen uptake, that carbon dioxide output and percentage oxygen extraction. And in that 9-0, this is used to collect, again, the expired air evaluation of the oxygen uptake using an indirect method during rest. All right, so I did an EP series last year where I broke down all the different components of billing for EP. It was a three-part webcast series, and we added a fourth advanced session during our boot camp. So I covered these last year, but I wanted to touch up on them again because I saw a very high volume of these services being reported by our congenital programs. So we're going to just touch up again on some of these. We had a new code added for some of the monitoring services. So again, this does have some updated information. So with the ambulatory monitors, so these are small, portable, electrocardiographic machines that are able to record the heart's rhythm. There are multiple types of monitors available, as you can see here. Each has a unique feature related to the length of recording time and the ability to send the recording. So we're going to cover the specifics of these different types of monitors next. So first, with an EKG, this is pretty standard. You know, almost all practices have this equipment within their office setting. It's pretty standard to be performed pretty frequently. So with this, it's a simple noninvasive test that checks for signs of heart disease. It records the electrical activity of your heart through the small electrode patches that the technician attaches to the chest, arms, and legs. And for pediatric patients, they can definitely just be all over their little chest. So reporting options, depending on what you have. So 12 lead EKG, which is the most standard that is performed. If you own your equipment and you're providing the interpretation along with that EKG strip, you would report the global code with the 93001. You would report the global code with the 93000. If you're doing a hospital round and the provider does, you know, evaluates that 12 lead EKG, they're only able to bill for the interpretation only because they don't own that equipment. So there you would report just the 93010 for the interp only. The telemetry strips, which is the one to three lead EKGs, a lot of times the carriers don't separately report this, especially if you're also reporting an E&M same day. If the service is being provided alone, you know, some carriers may still be reimbursing. So the 93040 is for the full global code. So that 93042 would be just for the interpretation and report only. So again, if you're doing a review in the hospital setting where you don't own that equipment, it's going to vary though. Like I said, most times we're also providing an E&M service same day and almost all carriers do not separately reimburse for that. And I do think that that is a typo right there. I will double check that. I think it should be a 4-1. We'll double check that and get that corrected. Okay. So different cardiovascular monitoring services. So we have different reporting options now. We did have a Category 3 code added at the start of this year. So a traditional Holter monitor is one that includes up to 48 hours of continuous recording. And how it's defined by CPT is 24 to 48 hours. If it's less than that 24 hours, there is guidance in the CPT book where it does state for you to reduce the service. But more commonly than not, we do see them at least worn for that 24 to 48 hours. Long-term continuous recorders, for a long time, these were from a vendor and called Xeo Patches. But they did graduate and get Category 1 codes several years ago. They did this year though add a new Category 3 service. So depending on how long the patient has ordered and worn the system is going to depend on your coding. So there's options for coding if it's greater than 48 hours up to 7 days. So remember with your traditional Holter, it's 24 to 48 hours. Then you have options for greater than 40 hours up to 7 days. Third option would be greater than 7 days up to 15 days. And the new code we have now can record greater than 15 days up to 30 days. Now this is new for this year. So previously, anything we saw that was up to a 30-day monitor would either fall under the mobile cardiac telemetry monitors or your event monitors because both of these can be worn up to 30 days. But now we have a long-term continuous monitor that can now also be 30 days. Most times when you're looking at the interpretation report itself, it does clearly define the service being provided. So I hardly ever see any issues with that in the documentation itself. But again, definitely make sure you're reporting these appropriately. If you see a 30-day monitor, don't just automatically assume it might be an MCOT or an event. It might fall under this long-term continuous recorder. And then with the mobile cardiac telemetry, the 93228 is for the interpretation. The 229 is for the technical review of the monitor strips themselves. This code is typically reported by the vendor. So from a physician professional perspective, unless you have an agreement with that vendor to report both and then just reimburse them for their portion, most times you're just going to be reporting your professional component to that. With the event monitor, this one is broken up to component codes, and we'll cover that on the next slide, because I have a really good slide that our team put together, and it breaks down all the different coding options for these services. So this is a good slide. I have it printed myself. So this breaks up the coding. So this is our continuous cardiac monitoring services, depending on how long the patient has it on. This is a typo here. This should be seven days here, and then this should be the 15, and this should be the 30 down here. Just this, oh, what happened? Sorry. Okay. So we'll get that fixed for sure, too. So this one is for your greater than 48 hours up to seven days, and again, a lot of practices don't do that technical piece of it where they're reviewing and scanning the analysis with report. A lot of times that's done through the vendor. So if you are reporting these as a component service, just remember you have the recording, which would include the hookup, recording, disconnecting, educating the patient on the device itself, and then we call that one the hookup code, and then you have your physician review and interpretation. So it's broken up for each level, just depending on how long that monitoring period is for. So again, if you're reporting only the component codes and you are hooking the patient up to the device in the office setting, if you're just mailing it to them, you're not really hooking them up to it. So a lot of times that is a no charge to the patient. But again, you will report your physician review and interpretation. With your MCOT code, like we covered already, this 229 is for that technical support. A lot of times this is reported by the vendor that's doing that scanning analysis. With your event monitor reporting, again, these are also broken up into component codes. The 93268 is the global code. So again, it would include all three of these. So if you are not providing that transmission and analysis technical piece to it, you're going to just break it up into the component coding, whether you do the hookup and or the review and interpretation. All right. So I saw lots of these in the data that was submitted. So again, that's why I wanted to cover these again. So we're going to look at our device implants now and whether the interrogations, the programming evaluations or your remote monitoring services. So this is language from CPT or the AMAs on an interrogation defined. It's an evaluation of an implantable device. It stores details. The stored details are retrieved from that implant and the retrieved information is evaluated to determine the current programming of that device. Components of an in-person interrogation vary depending on the type of system. A lot of our congenital patients, you know, mostly what I saw being reported as pacemakers. So again, not to say they couldn't qualify for another type of device, but again, these are the levels that are documented in the guidelines for just an interrogation only. So again, they're looking at the program parameters across any of the systems. You know, if they have leads, they're going to evaluate, look at the leads, battery, capture and sensing function. For a pacemaker, they're going to look and see if there's any heart rhythms that are captured. If it's a defibrillator device, they might be looking for any absence or presence of a VTAC type arrhythmia or ventricular fibrillation. With an ICM device, again, it's program parameters and analysis of at least one recorded cardiovascular data element from either an internal, external sensor. And then with our loop implants, our event monitor, implantable event monitors, those are program parameters, heart rhythm during recorded episodes, and it can be both patient initiated and device algorithm detected events when present. And again, these are just for the interrogation only. These are the codes available depending on the device that the patient has. If you have a device rep that may be coming in and doing the technical piece of it, then you're going to make sure you append the appropriate modifier for the professional component. If you run your own device clinic and you have your own staff that's downloading this data and evaluating it and sending to the physician for interpretation and review, then you can report just the full global code. So again, just some programs we work with do have representatives from the device vendor itself, and they come into the office and help download a lot of the data, and then the physician's just providing that professional piece to it. So it just depends on how you have that set up, whether or not you would report the global or append it with the professional modifier. CPT reporting instructions. So you report per procedure, may not be reported with programming on the same data service, may not be reported with remote interrogation services. So with remote interrogation services, let's say if the patient has a pacemaker that has a 90-day reporting period. So if the patient comes in the office and has just a pacemaker interrogated only, and they don't meet the requirements for the programming evaluation, the interrogation only, because even if it was done in person, if it's falling within the 90-day reporting period, you would not be able to report that in-person check. And that's a CPT rule. So again, sometimes with our congenital world, some carriers do make exceptions, you know, due to the patient's anatomy, their age and size. But just the standard guidelines with this, if you are doing a 90, you know, with a pacemaker, for instance, a 90-day remote monitoring period, any in-person interrogation only usually fall, and they usually bundle them in. So with programming evaluations. So programming evaluations are more work than just an in-person interrogation. So we're going to cover the specific differences with that required components with these. These are billable within a remote device service, though. So let's say our same patient that is within a 90-day remote period, and they come into the office, and their device is evaluated, and it needs to be reprogrammed. So you're going to be reporting now a reprogramming. Those do not fall within the remote monitoring period. So you should not have any issues getting those reimbursed if you're reporting the programming evaluation. So you can see these are the components, and you can see, like, the first five bullets are the same as an interrogation only. The additional bullets is the additional work that goes into a programming evaluation. So you know, a lot of times you may see lower and upper heart rates for a pacemaker, sensing values, AV intervals, those types of details. Same with the defibrillator, you know, you might be looking at the sensor rate response. Again, the lower and upper heart rates, you know, all those additional details. And then when you're looking at your subcutaneous rhythm monitor, they might also be making adjustments due to tachy and brady detections that they're seeing on the interrogation. So it's more work than just doing a standard interrogation. So let's say, though, that, you know, they don't need to make changes. So if they still evaluate all those parameters for a programming evaluation, even if they decide to not make changes, they've still done all the work for the programming evaluation itself. So some people look at how the codes are, you know, written, and they see the word programming and think, well, they didn't make any changes, I have to build an interrogation only. So again, no, if they're evaluating all of these bullets, it's a programming evaluation. So you still could report the service. So again, it's just going to depend on the level of detail and what is documented, what all they performed and evaluated, and whether or not it would fall under interrogation only or you truly can report a programming evaluation. So again, here's the coding options. Again, these also have the 26 TC modifiers applicable. So just make sure you're checking, you know, how your device clinic is set up and run. If you've got your own clinical staff that is actually downloading the information, then you're good to report the global code without that modifier. So again, here's the rules, and this is CPT guidance. You bill according to the number of leads or chambers, no service period, meaning if they're, you know, are within a remote monitoring period, these codes do not apply within that remote monitoring period. Does not require that a setting be reprogrammed. So this is actual guidance in what I was just describing. So again, if they're doing all the requirements of a programming evaluation and decide to leave the settings as they are, that is still fine, and you can still report it as a programming. Can only be done in person though. So these are not any way, shape, or form a remote service. And your physicians and device techs, they should understand and make the distinction between the difference between those interrogation evaluations and the programming. So again, what is the difference when you look at both? So are we actually interacting with the device? We're not just dumping the data into a report and having the provider interrogate it. If we are making adjustments, what are those adjustments? What are the details? Because as soon as you see adjustments done, you know you're hitting a programming evaluation. And then again, we may decide to leave it right where it was. It can still be a programming evaluation, even if we do not reprogram the device. So again, important to point that out. And then again, this is guidance that is printed in the CPT book. I put together a nice clean slide to look at so you can see the required components. If it's just an interrogation, and this just applies to our pacemaker or defibrillator devices, if they do these additional bullets here, and even if they don't make changes, you can report it as a programming evaluation. So now let's look at the remote monitoring services and how those work. So these are on a monitoring period. So it's important to stay within those applied period guidelines. You want to make sure that you're able to capture the clinic schedule to keep the patient on the period dates allowed. The device information is sent automatically or manually by the patient, depending on that system. And when that information is downloaded and reviewed in a finalized provider interpretation and signature, then that's, you know, depending on the monitoring period is when you would be able to report the service. So with the remote interrogation monitoring, the requirements are the same as an in-person interrogation. So again, you can see for the pacemaker, defibrillators, all the same bullet points. That is why if you do a remote interrogation and then you bring the patient within that remote monitoring period and do an in-person interrogation only, that is why they bundle because it's the same bullets that they have to document. So again, if they are doing a programming evaluation within the remote monitoring period, those are still reportable during the monitoring period. So with remote services, the code reported are broken into a technical component and a professional component. With the technical, this includes the receipt of the transmitted data, the technician review, and again, if you have your own monitoring staff, you know, sometimes it might be a registered nurse or you might have a qualified medical assistant that manages this data, they download it. You can report that technical code if your staff is downloading that data. But again, if it's a vendor from a specific device company that's downloading the data, they would report that technical download. And then there's also a professional component, which would include the review and analysis of that data that was submitted, and then the physician would document their interrogation of those findings. So these again are the codes depending on, oh my gosh, this G-code was deleted, I don't even know how I missed taking that out. So we'll fix that slide too, let me write that down. So this code was deleted a couple years ago. So it's just the professional, so these two codes can have the 26 and the TC modifier applicable to them now. But again, if you have your own clinic, you can report it just as the global code. So it would include both that technical and professional component to it. With your pacemakers or defibrillators, those are broken up with your professional interpretation, and then this is the technical download. And the reason these codes are the same is because it's just for the technician downloading the data. So there's no difference in the coding for that versus it being a pacemaker or defibrillator. So just to highlight again, an interrogation is an interrogation whether it's in-person or remote. Once a remote interrogation has been billed, any in-person interrogations performed within that period, in our ICM and our ILR systems, those are on a 30-day monitoring period. So again, their pacemaker defibrillators are the 90, and then there is language for the other monitors that says those are 30-day monitoring periods. So regardless of how the interrogation happens, whether it's remote or in-person, if you're within that remote monitoring period, just remember that in-person will most likely bundle. With the ICM services, again, these are on a 30-day, not a 90-day. It does have language in the guidelines that states there has to at least be a minimum of a 10-day wording in CPT. A lot of times, these devices are used in congestive heart failure management, pulmonary hypertension, et cetera. So it could just depend on the type of the device that they have implanted. With our loop implants, these are also on a 30-day monitoring period. In-person interrogation is not billable within that remote 30-day monitoring period. The in-person programming is, though, separately reportable, and they also have language that states a 10-day minimum. All right, well, that brought us to the end. Let me find my Q&A box. I've got a few minutes to answer some questions. All right, some of these are surgery-related, so I'll have to do those after. So here's a question. Are PFO and the bicuspid aortic valve the only congenital heart defects that do not support reporting the 93303 for the congenital echocardiography? From CPT Assistant, those are the only two conditions I saw referenced in that CPT Assistant article. I did go back and look at all articles that I could find related to echocardiography services, and those, again, were the only two conditions that they did reference for the congenital echoes. If the provider is performing a regular TEE with 3D, not looking at congenital defects, can we still report the 93319? There is definitely some controversy on that. When you look at the societies and what they have put out, I know that when you look at the CPT book itself, it does reference with that new 3D code, the 93319, that the traditional standard TEE codes can also be reported with that. But when you look at the CPT definition of the 93319, it does state for congenital cardiac anomalies. So the societies have put out that they would not report those together. I know some practices have made a decision because of how the CPT is defined and how it does reference the regular TEE code. Some practices are trying to report them together. I don't know if there have seen any trends with denials and such though. So again, you could try since it does reference it, but how the 3D echo is defined, it does reference to congenital cardiac anomalies. Somebody's asking if can 93005, which is a EKG strip, can it be reported the same day as a Holter monitor hookup? So it's going to depend on your documentation. So most times when the patient's initially seen, you know, they have their E&M visit with the provider, the EKG is ordered and performed, and then once the provider assesses that patient, they may decide from that assessment, they also want to do a Holter monitor on that patient. So if you have medical necessity for both, they will need a modifier. So the EKG will bundle with that Holter monitor hookup. So if you have medical necessity for both, then yes, you could report them both. But just again, documentation would need to support and you would need a modifier to append to that. Can you cover what data service to use for the different device checks? So common question we get, most times this is related to the remote checks. So this is going to be dependent on what your practice decides to follow. So check with your specific carriers. The carrier did put an MLN matter several years ago when it came to cardiac monitoring services. We see programs, most carriers, as long as you stay consistent, are fine with what you decide to do. So some programs use the signature date of the device, remote device interrogation from the physician. Some use a date of download from when the device interrogation, when the technician downloaded the data. Carriers stay consistent within that monitoring period itself. So again, check with your carriers because this is definitely can vary just depending on that specific carrier and how your program decides to move forward with a consistency basis on this. We're asking specific diagnosis related codes, so I would have to look those up in my book. The add-on codes for a regular adult echo, there was a list of what to look for to determine if Doppler was done. Yes, there is a slide that breaks down the different components of the spectral Doppler along with that color flow Doppler and what you would see in that documentation. If you're not clear, it's always just best to go back to your provider and, you know, ask them directly what they meant by that and what technology might have been used during that study. All right, well, we are at 2.30. I can't even believe that went by fast. So I'll get those couple slides updated because I'm just still a little bit mind blown that I had that G-code in there because I know it was deleted several years ago. So I'm definitely sorry about that. We'll get these slides updated and uploaded to our platform so that way you can download the updated version from there. I appreciate all your time today. Please make sure you register for our second series. We'll be doing that, I believe, on the 29th of this month and look forward to seeing you all next time. Thanks.

congenital heart defects

non-invasive diagnostics

Jamie Quimby

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coding

CEU certificates

Medaxium Academy

echocardiography

atrial septal defect

cardiac imaging

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