Billing and Coding: Echocardiography

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 Diagnosis Code Requirements

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Echocardiography L37379.

Follow-up Studies or Limited Studies

When a less than complete examination is performed for the purpose of evaluation of 1 specific cardiac problem, or region of the heart, the service is described by CPT^® codes 93308 and 93321, follow-up or limited studies. When a limited service is performed, or the patient’s condition requires only a limited examination, these codes must be used to indicate the appropriate service.

Examples of appropriate use of CPT^® code 93308:

• a follow-up study of a patient with pericardial effusion following heart surgery, to evaluate progression or resolution of the effusion; or
• a serial evaluation of left ventricular (LV) function during antineoplastic chemotherapy

Examples of appropriate use of CPT^® code 93321:

• recording tricuspid regurgitant velocity in order to estimate pulmonary artery systolic pressure; or
• sequential evaluation of the transmitral velocity profile in a patient with mitral stenosis, in order to evaluate for a change in gradient or valve area

Doppler Color Flow Velocity Mapping

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.

Limitations

When ultrasound (US) contrast enhancement is used for visualizing the ventricular chambers and endocardial border, the supply is considered separate from the procedure for reimbursement from Medicare.

Noncovered

When a screening test is performed, use the appropriate screening ICD-10 code to indicate the test is being done for screening purposes. When the result of the test is abnormal, subsequent services may be billed with the test-result diagnosis; however, the initial screening test must be listed as screening, even though the result of the screening test may be a covered condition.

Diagnostic injection services are an integral part of a contrast procedure and are not separately payable.

Transesophageal Echocardiography (TEE)

Use of intraoperative TEE for monitoring purposes (CPT^® code 93318) performed by the anesthesiologist during cardiopulmonary surgery (e.g., cardiopulmonary bypass and valvular surgery) is included in the reimbursement for the anesthesia service and not separately reportable.

Note: When 2 (or more) imaging studies are routinely billed (i.e., without a supporting clinical indication), only 1 of the services will be allowed and the other(s) will be denied as not medically necessary.