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This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Transesophageal Echocardiography (TEE).
The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attached determination.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Echocardiography is a non-invasive technique in which pulsed high-frequency sound waves are used to visualize the contours, movements and dimensions of cardiac structures. Ultrahigh frequency sound waves are directed toward and reflected by cardiovascular structures.
CPT code 93312 – Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report describes the entire TEE service when it is performed by a single physician with or without the assistance of a sonographer for image acquisition.
Valvular Prostheses (Mechanical and Bioprostheses): In most patients with valvular prostheses, TTE provides diagnostic functional information and non-invasive serial follow-up. However, in some patients, the prosthetic valve may cause acoustical shadowing that may diminish the value of the TTE.
It merits emphasis that a negative examination ( TTE or TEE) does not exclude a cardiac embolus, and the finding of thrombus or vegetation does not establish a cardiac embolic source.
Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is: Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member. Furnished in a setting appropriate to the patient’s medical needs and condition. Ordered and furnished by qualified personnel.
Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is: 1 Safe and effective. 2 Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary). 3 Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:#N#Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.#N#Furnished in a setting appropriate to the patient’s medical needs and condition.#N#Ordered and furnished by qualified personnel.#N#One that meets, but does not exceed, the patient’s medical need.#N#At least as beneficial as an existing and available medically appropriate alternative.
CPT Codes for Echocardiogram and Echocardiography are codes related to Cardiovascular (CPT Code 92950 - 93799 ) under Medicine Section, in the Category I of CPT Codes. There are several CPT Codes for Echocardiogram and Echocardiography, depending on the techniques and procedures of Echocardiogram and Echocardiography performed.
The most commonly used technique of Echocardiogram and Echocardiography is Transthoracic Echocardiogram (TTE). For TTE, the transducer is moved around different parts of chest and upper stomach.
The last technique of Echocardiogram and Echocardiography is TEE or Transesophageal Echocardiogram. For TEE, an anesthetic is applied on the back of esophagus or throat, and a transducer in the form of a probe is inserted down the esophagus or the throat. The placement of the transducer probe through the esophagus for TEE makes the image of the heart become clearer than the other techniques of Echocardiogram and Echocardiography since the transducer probe is placed nearer the heart without the blockage from the rib cages and the lungs.