Local Coverage Determination (LCD)

Transesophageal Echocardiogram

L33756

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L33756
Original ICD-9 LCD ID
Not Applicable
LCD Title
Transesophageal Echocardiogram
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 10/01/2019
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Issue

Issue Description
Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Transesophageal Echocardiogram. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for Transesophageal Echocardiogram and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.

Internet Only Manual (IOM) Citations:

  • CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
    • Chapter 15, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
  • CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual,
    • Chapter 1, Part 4, Section 220.5 Ultrasound Diagnostic Procedures (Effective May 22, 2007)
  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 4, Section 20 Reporting Hospital Outpatient Services Using Healthcare Common Procedure Coding System (HCPCS)
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD

 National Correct Coding Initiative (NCCI) Citation:

  • NCCI Policy Manual for Medicare Services,
    • Chapter 11, Section I. Cardiovascular Services, Subsections 15., 21., 24., and 32.
    • Chapter 11, Section U. Evaluation and Management (E&M) Services, Subsection 9. 

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. 
  • Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations. 
  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

Federal Register References:

  • Code of Federal Regulations (CFR), Title 42, Volume 2, Chapter IV, Part 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions and Part 410.33 Independent diagnostic testing facility.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

History/Background and/or General Information

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.

Transesophageal Echocardiography (TEE) imaging is a viable alternative when transthoracic imaging is problematic or difficult. In many instances, abnormalities can be displayed that are missed with standard diagnostic techniques, and the images displayed are often of superior quality because of the high-resolution probes that can be used.

Covered Indications

Transesophageal echocardiogram will be considered medically necessary in any of the following circumstances:

  • Examination of prosthetic heart valves, primarily mitral
  • Arrhythmias – assessment of patients with certain cardiac arrhythmias [atrial fibrillation, atrial flutter] for which the results of the test will influence treatment decisions. TEE may complement transthoracic echocardiography particularly to assess for left atrial thrombus.
  • Detection of:
    • aortic dissection
    • atrial septal defect
    • congenital heart disease
    • embolism or thrombosis, primarily involving left atrium
    • intracardiac foreign bodies, tumors or masses
    • mitral valve regurgitation
    • vegetative endocarditis
  • Intra-operative guide to left ventricular function
  • Inadequacy of transthoracic echo due to:
    • chest wall deformity, COPD
    • open heart or chest surgery
    • chest trauma
    • obesity

Limitations

As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.

Summary of Evidence

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Analysis of Evidence (Rationale for Determination)

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Proposed Process Information

Synopsis of Changes
Changes Fields Changed
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Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
View Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

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Additional ICD-10 Information

General Information

Associated Information

Documentation Requirements

Please refer to the Local Coverage Article: Billing and Coding: Transesophageal Echocardiogram (A57179) for documentation requirements that apply to the reasonable and necessary provisions outlined in this LCD.

Utilization Guidelines

Please refer to the Local Coverage Article: Billing and Coding: Transesophageal Echocardiogram (A57179) for utilization guidelines that apply to the reasonable and necessary provisions outlined in this LCD.

Sources of Information

First Coast Service Options, Inc. reference LCD number(s) – L29028, L29294, L29401

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:e269-e367.

ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. Journal of the American Society of Echocardiography. 24:229-267.

Ferri, F (2004). Ferri’s BEST TEST. A Practical Guide to Clinical Laboratory Medicine and Diagnostic Imaging. Mosby’s Inc.

HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up. Heart Rhythm. Volume 4, No 6, June 2007.

Miller, R (2005). Miller’s Anesthesia sixth edition. Elsevier, Inc.

Rakel, R; Bope, E (2005). CONN’s Current Therapy 2005. Elsevier, Inc.

Zipes, D; Libby, P; Bonow, R (2005). Braunwald’s Heart Disease, A Textbook of Cardiovascular Medicine, 7th edition. Elsevier, Inc.

Bibliography

N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
10/01/2019 R7

Revision Number: 4
Publication: September 2019 Connection
LCR A/B2019-058

Explanation of Revision: Based on Change Request (CR) 10901, the LCD was revised to remove all billing and coding and all language not related to reasonable and necessary provisions (“Bill Type Codes”, “Revenue Codes”, “CPT/HCPCS Codes”, “ICD-10 Codes that Support Medical Necessity”, “Documentation Requirements” and “Utilization Guidelines” sections of the LCD) and place them into a newly created billing and coding article. During the process of moving the ICD-10-CM diagnosis codes to the billing and coding article, the ICD-10-CM diagnosis code ranges were broken out and listed individually. In addition, the Social Security Act, Code of Federal Regulations, and IOM reference sections were updated. The effective date of this revision is for claims processed on or after January 8, 2019, for dates of service on or after October 3, 2018.

Based on CR 11322/CR 11333 (Annual 2020 ICD-10-CM Update) the newly created Billing and Coding Article was revised. Added ICD-10-CM diagnosis codes I26.93, I26.94, I48.11, I48.19, I48.20, and I48.21. Deleted ICD-10-CM diagnosis codes I48.1 and I48.2. The effective date of this revision is for dates of service on or after 10/01/19.

10/01/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.

  • Revisions Due To ICD-10-CM Code Changes
  • Other (Revisions based on CRs 10901, 11322, 11333)
01/01/2018 R6

01/18/2019: Based on a review of the LCD, grammatical and/or typographical errors were identified and corrected.

  • Typographical Error
01/01/2018 R5

2018 HCPCS revisions.  Descriptor for CPT Code 93355 was changed in Groups 1 and 2.

  • Revisions Due To CPT/HCPCS Code Changes
10/01/2017 R4

 

Revision Number:  4

 

Based on CR 10153 (2018 ICD-10 Update) LCD was evaluated and impacts identified. The new ICD-10-CM changes are effective for dates of service on or after 10/01/2017.

 

  • Revisions Due To ICD-10-CM Code Changes
10/01/2016 R3 Revision Number: 1 Publication: October 2016 Connection
LCR A/B2016-097

Explanation of Revision: Based on CR 9677 (Annual 2017 ICD-10-CM Update) the LCD was revised. Revised diagnosis range Q20.0-Q25.2 to read Q20.0-Q25.29 and revised the descriptor. Deleted diagnosis code Q25.2. Revised descriptors for diagnosis code ranges T82.827A-T82.827S, T82.837A-T82.837S, T82.847A-T82.847S, T82.857A-T82.857S, T82.867A-T82.867S. The effective date of this revision is based on date of service.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 Revision Number: 1 Publication: October 2016 Connection
LCR A/B2016-097

Explanation of Revision: Based on CR 9677 (Annual 2017 ICD-10-CM Update) the LCD was revised. Revised diagnosis range Q20.0-Q25.2 to read Q20.0-Q25.29 and revised the descriptor. Deleted diagnosis code Q25.2. Revised descriptors for diagnosis code ranges T82.827A-T82.827S, T82.837A-T82.837S, T82.847A-T82.847S, T82.857A-T82.857S, T82.867A-T82.867S. The effective date of this revision is based on date of service.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R1 3/13/2015: The language and/or ICD-10-CM diagnoses were updated to be consistent with the current ICD-9-CM LCD’s language and coding.
  • Revisions Due To CPT/HCPCS Code Changes
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Associated Documents

Attachments
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Related Local Coverage Documents
Articles
A57179 - Billing and Coding: Transesophageal Echocardiogram
Related National Coverage Documents
N/A
Public Versions
Updated On Effective Dates Status
10/02/2019 10/01/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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