Doppler Echo Color Flow Velocity Mapping March 1, 2001 Catherine A. Dolfi Medical Policy Pennsylvania Blue Shield Camp Hill, PA 17089 Dear Ms. Dolfi: The Pennsylvania Chapter of the American College of Cardiology (ACC) thanks you for the opportunity to provide comments regarding Doppler echocardiography color flow velocity mapping (procedure code 93325). The ACC is a leader in the development of clinical guidelines and post-graduate education related to the diagnosis and treatment of cardiovascular disease. As such, the ACC, in collaboration with the American Heart Association (AHA), has published the Echocardiography — Valvular Heart Disease Guideline. The Guideline specifically notes that with development of Doppler echocardiography, it has become possible to precisely localize and quantitate obstruction in the cardiovascular system. This information, when considered with flow volume information provided by Doppler flow integrals, allows a plethora of physiological and functional information to be obtained non-invasively. Moreover, the differing capabilities of the several types of available Doppler echocardiographic techniques, including color flow velocity mapping, have specific strengths that enable a cardiovascular specialist to provide more accurate diagnosis and treatment. Color Doppler information is particularly useful in the assessment of valvular heart disease and congenital heart disease and cannot be replaced by cardiac Doppler (continuous wave and pulsed wave Doppler). The latter modalities, also known as spectral Doppler, are useful in numeric quantification of blood flow velocity and flow characteristics; whereas color flow Doppler is essential in screening for septal defects and valvuar insufficiency among other things. Typically, color Doppler and either cardiac Doppler or limited cardiac Doppler are done at the same time in a patient because of their complimentary nature. This is analagous to the measurement of left ventricular pressure when performing a left ventriculogram. Performance and interpretation of color flow Doppler is a very substantial component of the total effort involved in echocardiography — both for technologist and physician alike. The Health Care Financing Administration (HCFA) recognizes the physician work and value of color flow Doppler (CPT Code 93325) and has assigned this code a relative value unit (RVU which which includes a physician work component. This is an indication of the extra work associated with this procedure. HCFA recognizes payment for this code. Furthermore, this code is not included in the Correct Coding Initiative bundling efforts. It is a separately recognizable procedure and should not be bundled into the primary echocardiography code. The Pennsylvania Chapter of the ACC requests that Pennsylvania Blue Cross/Blue Shield recognizes the added value of color flow technology and the additional work involved in performing this procedure. It should be emphasized in this context that color flow Doppler and spectral Doppler are different procedures. Should you have any questions or require further information, please contact me directly. We are happy to discuss this issue with you in greater detail if necessary. Sincerely, Alan H. Gradman, MD, FACC