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Append modifier 52 for ‘limited’ stress echocardiography for TAVR

Question: Our clinic’s echocardiography department has started doing limited echoes with Dobutamine for stress with patients who have severe aortic stenosis to see if they qualify for a transcatheter aortic valve replacement (TAVR) procedure. Our head echo tech wants to know how to bill these.

Answer: There is no code for a limited echocardiogram. Instead, append modifier 52 (Reduced services) to code 93350 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-Mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report) or 93351 (…; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional).

If performed in a facility, append modifier 26 to the echo code to report the professional component. In the office setting, you may also report code J1250 for the Dobutamine.