Full Answer
• CPT code 93318 – Echocardiography, transesophageal (TEE) for monitoring purposes is used to describe intraoperative TEE that is performed to monitor the patient’s cardiovascular function during surgery or another intervention.
Transesophageal Echocardiography (TEE) is a cardiac diagnostic procedure in which a modified endoscope, with an ultrasound transducer, is passed into the esophagus and/or stomach in order to obtain 2-D/3D echo images and spectral and color doppler information about the heart and its great vessels.
93303–Transthoracic Echocardiography for congenital anomalies; complete *Please note codes 93303-93304 are to be used for patients with congenital anomalies only
+ 93325 – Doppler echocardiography color flow velocity mapping Medicare now has a combined CPT Code for Echocardiograms 93306 to replace the combined codes of 93307, 93320 & 93325. The 93306 reimbursement is 15% less than the combined three codes: 93325 – Doppler echocardiography color flow velocity mapping
Answer: If the cardiologist placed the probe and acquired the images, the correct code for the TEE is 93312 (Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report).
ICD-10-CM code Z01. 89 should be reported when a TEE is performed during an open chest procedure. ICD-10-CM code Z01. 89 should be reported as the primary diagnosis and the reason for the surgical procedure should be coded as the secondary diagnosis.
CPT code 93318 (echocardiography, transesophageal for monitoring purposes) is not billable during the intraoperative period.
CPT® 93320 in section: Doppler echocardiography.
Echocardiogram 93306 | Healthscan Imaging.
ICD-10-PCS Code X2JAX47 - Inspection of Heart using Transthoracic Echocardiography, Computer-aided Guidance, New Technology Group 7 - Codify by AAPC.
37.28 Intracardiac echocardiography - ICD-9-CM Vol.
Intracardiac Electrophysiological Procedures/CPT® Code 93653 - Intracardiac Electrophysiological Procedures/Studies - Codify by AAPC.
Transthoracic EchocardiographyApplicable CPT CodeDescription93303Transthoracic echocardiography for congenital cardiac anomalies; complete93304Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study5 more rows
CPT 93303 is for congenital transthoracic echo. CPT 93306 is for non congenital transthoracic echo.
Cardiovascular stress testCPT® 93016 in section: Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress.
However CPT Assistant states: "In the facility setting, CPT code 93350 is always used to report the performance and interpretation of a stress echocardiogram since the alternative stress echocardiography code 93351 is reportable only in the non-facility setting."
Moderate SedationCPT Code 99144 describes Moderate Sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, for patients 5 years of age or older for the first 30 minutes of intraservice time.
CPT® 93325 in section: Doppler echocardiography.
Unless TTE is technically inadequate and clinical data is insufficient for a management decision, TEE will not be covered. Transthoracic echocardiographic assessment of left ventricular function is considered preferable to TEE in all other circumstances.
The list of ICD-10 codes for this secondary diagnosis will be found in the LCD for Transthoracic Echocardiography, L34338, under the list of payable ICD-10 codes for CPT codes 93303 and 93304, and the list of payable ICD-10 codes for CPT codes 93306, 93307 and 93308.
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY
procedure code and description 93312- Echo transesophageal - average fee payment- $300 - $ 320 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…
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. Reflected echoes are translated into electrical impulses for display on a monitor and for recording and storage on either videotape or digital recording.
Suspected Cardiac Thrombi and Emboli:Historical estimates place the incidence of a cardiac source of emboli at between 15 and 30 percent. Selective study of these patient cohorts by TTEdetects a potential cardiac source in 10 percent. In general, TTEcan reliably diagnose or exclude a ventricular locus of potentially embolic material. In patients with cardiac pathology associated with a high incidence of thromboembolic (valvular heart disease, arrhythmias – especially atrial fibrillation, cardiomyopathies, other causes of ventricular dysfunction) the incremental information provided by TEEshould be of therapeutic relevance before the patient is subjected to TEE. Routine TEEto search for a cardiac source of embolization is not considered necessary. In younger stroke patients with a normalTTEand neurologic workup, TEEis appropriately considered. A key decisional factor should be whether TEEfindings may substantively alter therapy and clinical outcome. It merits emphasis that a negative examination (TTEor TEE) does not exclude a cardiac embolus, and the finding of thrombus or vegetation does not establish a cardiac embolic source.
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.
Medicare payment for the professional component of intraoperative TEE is justified for instances in which intraoperative echocardiography is an adjunct to optimal performance of a surgical procedure or for a specific diagnostic reason (e.g., proper valve placement, guiding of the placement of a device to close an atrial septal defect, evaluation of mitral balloon valvuloplasty, etc.). Intraoperative echocardiographic services must include a complete interpretation and written report by the performing physician, and images obtained must be stored in the same manner as other echocardiographic services to warrant separate payment.
Transesophageal echocardiogram will be considered medically necessary in any of the following circumstances (see Covered ICD-10 Codes):
93225-The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the heart that shows the velocity and direction of blood flow in different colors.
An echocardiograph uses high–frequency sound waves to assess the velocity and direction of blood flow in the cardiac arteries. The sound waves are transmitted into the body, bounce back, and are again captured by a transducer. These captured waves are converted into images with the help of advanced digital processing technology. The speed and the direction of blood flowing in normal vessels (laminar flow) are synchronized with the pumping action of the heart, and the speed of the red blood cells moving along the flow of blood in the arteries in a particular region is always the same. But when there is any abnormality in the vessel (e.g., a blockage, narrowing, or leakage.), the flow pattern and speed become irregular (turbulent flow) which is easily detected by the echocardiograph and reproduced as images in a screen. The Doppler transducer is different than the normal echo transducer.
The sonographer moves a transducer over the gel–smeared chest wall at various angles and at different positions over the heart so that a complete picture of the heart can be obtained. To achieve better image recording, the sound waves should be targeted as parallel to the blood flow as possible. The echoes received from the heart and the RBCs in the blood are converted by a complex computer program into two–dimensional images of the heart that will be displayed on a computer screen. The computer program adds on more specific color layers that indicate blood flow pattern in a clearer way.
The sonographer moves the transducer at various angles and at different positions over the location of the heart so that a complete picture of the heart can be obtained . The transducer transmits powerful sound waves that will pass through the gel layer and breast bones and bounce back upon falling onto the heart.
The sonographer will hold a small hand–held instrument known as the transducer and will move the device over the gel–smeared chest wall skin of the subject.
At the beginning of the procedure the subject (the person on whom the procedure is performed) is instructed to take off his clothing to the waist level. Women are provided a gown to wear. The person lies down on the examination table. During the examination the room will remain dimly–lit.
3. Left atrial appendage: There is no thrombus.
You may need a combination of a TEE, Doppler ultrasound and color Doppler to get information about how blood flows across your heart’s valves.
Check for abnormalities in the top left chamber of your heart (left atrium)
A transesophageal echo (TEE) test is a type of echo that uses a long, thin, tube (endoscope) to guide the ultrasound transducer down the esophagus (“food pipe” that goes from the mouth to the stomach).
The test is used to: Check how well your heart’s valves and chambers are working. Look for problems, such as valve disease, myocardial disease, pericardial disease, infective endocarditis, cardiac masses and congenital heart disease. See how well your heart valves are working after surgery.
You will lie on your left side on an exam table.
Someone should come with you the day of the test to drive you home. You should not drive until the day after the procedure. The sedation given during the test causes drowsiness, dizziness and impairs your judgment, making it unsafe for you to drive or operate machinery.
Stress echocardiography is not typically performed during the acute phase of a MI when a diagnosis has been established by other methods. In selected patients, stress echocardiography may be necessary when the evaluation could contribute significant information to the patient’s condition or treatment plan.
Evaluation of diastolic filling parameters by Doppler echocardiography is being used to help establish the prognosis in patients with congestive heart failure and systolic dysfunction as well as to evaluate appropriate parameters of medical treatment.
Recognition of the relative contributions of myocardial and valvular functional perturbations to a clinical presentation is facilitated. TTE aids in the recognition of myopathies and their classification into hypertrophic, dilated and restrictive types. Without clinically documented, discrete (abrupt change in signs and symptoms) episodes of deterioration, it is not generally medically necessary to repeat TTE assessments more frequently than annually, unless done to evaluate the response to therapeutic intervention.
TTE can detect ischemic and infarcted myocardium. Regional motion, systolic thickening perturbations and mural thinning can be quantitated and global functional adaptation assessed. The relative contributions of right ventricular ischemia and/or infarction can be evaluated. Complications of acute infarction (e.g., mural thrombi, papillary muscle dysfunction and rupture, septal defects, true or false aneurysm and myocardial rupture) can be diagnosed and their contribution to the overall clinical status placed in perspective. In the setting of acute infarction, repeat study will typically be dictated by the clinical course. If available, the use of contrast agents may improve diagnostic efficiency, and eliminate the need for additional radionuclide testing. Without clinical deterioration or unclear examination findings, repeat assessment is typically performed at discharge. The medical record must document the medical necessity of more frequent TTE assessments.
9330 8 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
The technical component of TTE must be done under the general supervision of a qualified physician, appropriately trained and skilled in the performance and interpretation of echocardiography. Stress echocardiography is Medicare-covered only when performed under the direct supervision of a qualified physician who provides:
Medicare does not cover this service when performed routinely with all echocardiographic exams (i.e., without a clinical indication). This is true even when the results of the test reveal abnormalities. If an unsuspected finding on TTE indicates medical necessity for additional study with Doppler color flow velocity mapping, it can be covered. When the test is performed without a specific indication, it is considered routine screening, and must be billed with a screening ICD-10 code to indicate the reason for the test.
Medicare has established a family of HCPCS “C” echocardiography codes that describe reporting of contrast administration. These codes should be reported by the hospital when an outpatient contrast echo procedure is performed in place of the conventional CPT codes (e.g., 93306, 93351, etc.). In addition to reporting the contrast procedure, hospitasl should report the applicable contrast agent “Q” code. Per the NCCI manual and correct coding edits, Medicare does not allow separate reporting for the IV insertion or injection procedure. Private payers may or may not use these codes. Check with payers.
Beginning January 1, 2017, moderate sedation is no longer part of the TEE service payment. Moderate sedation must be separately reported with new CPT codes and documented, when performed. This is important as the moderate sedation service was previously included in the TEE relative value units (RVUs). If moderate sedation codes are not separately reported, payment for the service will be lost.
While category III codes are not nationally reimbursed by CMS, these codes may be reimbursed by private payers—ASE is meeting with private payers in an effort to establish reimbursement. Additionally, CMS will track submission of these codes. There will be an opportunity for this code to progress to Category I status over the next few years based on 1) utilization and 2) additional peer reviewed publications demonstrating efficacy.