Transthoracic Echocardiography (TTE) (L28565)
Contractor Information
|
Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L28565 LCD Title Transthoracic Echocardiography (TTE) Contractor's Determination Number CV-026 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 03/25/2009 Original Determination Ending Date Revision Effective Date For services performed on or after 10/01/2011 Revision Ending Date |
CMS National Coverage Policy
CMS
Publication 100-4, Medicare Claims Processing Manual, Chapter 12,
section 30.4, allows physician/practitioner billing contrast material
for use in echocardiography. Manual System, Medicare Claim Processing
Manual (Pub. 100-4, Chapter 9, § 100; Chapter 12, §30.4
CMS Publication 100-3, Medicare National Coverage Determination Manual, Chapter 1, Part 1: 20.15 Electrocardiographic Services.
CMS Publication 100-4, Medicare Claims Processing Manual, Transmittal No. 795, Change Request #4208, dated 12/30/2005, redefines type of bill (TOB) 14X for non-patient laboratory specimens-CR 3835 Manualization, including Critical Access Hospitals
CMS Publication 100-4, Medicare Claims Processing Manual, Transmittal No. 820, Change Request #4210, dated 02/01/2006, sites of service revenue codes for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
CMS Publication 100-4, Medicare Claims Processing Manual, Transmittal No. 1417, Change Request #5912, dated 01/18/2008, Update of the Hospital Outpatient Prospective Payment System (OPPS)
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 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered medically reasonable and necessary.
Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Publication 100-3, Medicare National Coverage Determination Manual, Chapter 1, Part 1: 20.15 Electrocardiographic Services.
CMS Publication 100-4, Medicare Claims Processing Manual, Transmittal No. 795, Change Request #4208, dated 12/30/2005, redefines type of bill (TOB) 14X for non-patient laboratory specimens-CR 3835 Manualization, including Critical Access Hospitals
CMS Publication 100-4, Medicare Claims Processing Manual, Transmittal No. 820, Change Request #4210, dated 02/01/2006, sites of service revenue codes for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
CMS Publication 100-4, Medicare Claims Processing Manual, Transmittal No. 1417, Change Request #5912, dated 01/18/2008, Update of the Hospital Outpatient Prospective Payment System (OPPS)
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 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered medically reasonable and necessary.
Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Indications and Limitations of Coverage and/or Medical Necessity
Transthoracic
echocardiography (TTE) affords unique insight into cardiac structure
and function. Two-dimensional imaging (2D) defines the configuration and
changing dimensions of the chambers; dynamic cyclic variation in
myocardial thickness; and the associated valvular motions throughout the
cardiac cycle. Superimposition of Doppler velocity recordings (with
volumetric flow calculations) provides an integrated picture of cardiac
structure, function, and adaptation to both normal and abnormal
physiology.
The proximal great vessels and the pericardium can also be directly visualized.
The plethora of structural and functional information provided by TTE is unique among diagnostic testing modalities. The rapid and noninvasive acquisition of this information has contributed to exponential application; and to potential over-utilization. This policy addresses the medical necessity and reasonable application of TTE. Transesophageal echocardiography (TEE) and intraoperative transesophageal echocardiography is the subject of a separate policy statement. (See WPS LCD CV-007).
Echocardiography is indicated in the evaluation of derangement of valvular, myocardial and pericardial function. The applications for general coverage include:
1. Ventricular Function and Cardiomyopathies
Changes in myocardial thickness (hypertrophy and thinning) in derived parameters of
contractility, and in chamber volume and morphology can be quantitated and charted
over time by TTE. Cardiac responses to volume perturbations, chronic pressure excess
and therapeutic interventions can be monitored. Recognition of the relative contributions
of myocardial and valvular functional perturbations to clinical presentation is facilitated.
TTE aids the recognition of myopathies and their classification into hypertrophic, dilated
and restrictive types. Absent clinically documented, discrete (abrupt change in signs and
symptoms) episodes of deterioration, it is not generally medically necessary to augment
clinical assessments with TTE measurements at more frequent than annual examinations.
Although TTE is used in the assessment of ventricular diastolic function, reproducible
pathognomonic findings are not well established. In individuals with signs and/or
symptoms suggestive of ventricular dysfunction, the demonstration by TTE of normal
systolic function and/or ventricular hypertrophy may suggest the presence of diastolic
functional abnormalities
2. Hypertensive Cardiovascular Disease
Left ventricular hypertrophy (LVH) correlates with prognosis in hypertensive
cardiovascular disease. Certain antihypertensive medications have been reported to
stabilize and possibly contribute to the regression of left ventricular hypertrophy and the
insidiously progressive development of left ventricular dysfunction and dilatation. In
young individuals and in individuals with borderline hypertension, the decision to
commit to long-term antihypertensive therapy may be determined by the presence of left
ventricular hypertrophy. TTE may assist in the decision to treat through analysis and the
formulation of a treatment program. Baseline TTE and periodic serial assessment (no
more frequently than annually) would be medically appropriate. More frequent
assessment should have explicit contemporaneous medical necessity documentation.
3. Acute Myocardial Infarction and Coronary Insufficiency
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 (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. Following an initial TTE in the setting of acute infarction, repetition
frequency will typically be dictated by the acute clinical course. Absent clinical
deterioration or unclear examination findings, repeat assessment typically includes an
evaluation at discharge. Convalescent evaluation, at approximately six (6) months and
annually thereafter, generally provides adequate supplemental data to a thoughtful
clinical evaluation. The medical record should document the medical necessity of more
frequent TTE assessment.
4. Exposure to Cardiotoxic Agents (chemotherapeutic and external)
Measures of myocardial contractility, thinning and dilation are important in the titration
of therapeutic agents with known myocardial toxicity. Baseline assessment, bimonthly
during and at six (6) months following therapy is generally considered medically
appropriate. Following accidental exposure to known myocardial toxic agents, absent
abrupt change in clinical signs and/or symptoms, typically annual assessment would be
considered medically necessary.
5. Cardiac Transplant and Rejection Monitoring
TTE is an integral part of the cardiac donor selection and donor-recipient matching
process. Evaluations focus on analysis of ventricular function and valvular integrity.
TTE is also incorporated into the management of allograft recipients. Myocardial
thickness, refractile properties, contractile patterns and indices, restrictive
hemodynamics, and the late development of pericardial fluid may alert to a rejection
episode. None of these findings has achieved diagnostic sensitivity or specificity.
Typically, TTE is performed weekly for the first four-to-eight (4-8) weeks following
transplant, with decremental frequency over time. Absent acute rejection episodes,
approximately two (2) TTE examinations are typically performed yearly in chronic
transplant recipients. TTE of cardiac allografts is most appropriately serially performed
at transplant centers by examiners with expertise in the management of cardiac allograft
recipients. Use in excess of the generally accepted frequency will require appropriate
medical necessity documentation.
6. Native Valvular Heart Disease
Detection of mitral stenosis was among the first practical clinical applications of TTE.
TTE is well established as a technique of primary choice for the evaluation of valvular
pathology and its effect upon global myocardial function. The relative severity of multivalve
pathologies can be quantified. Visualization of the valve and valvular apparatus
facilitates therapeutic decisions when competing therapeutic options exist, especially
interventions for mitral stenosis. Absent acute intervention, or a discrete change in
otherwise stable clinical signs and symptoms, TTE in chronic valvular disease is used to
document course over time. Generally, it is not medically necessary to repeat these
examinations more frequently than bi-annually.
7. Prosthetic Heart Valves (Mechanical and Bio-prostheses)
TTE assessment soon after prosthetic valve implant is important in establishing a baseline
structural and hemodynamic profile unique to the individual and the prosthesis. Size,
position, underlying ventricular function and concomitant valve pathologies all impact
this unique profile. Reassessment following convalescence (3-6 months) is appropriate.
Thereafter, absent discretely defined clinical events or obvious change in physical
examination findings, annual stability assessment is considered medically reasonable and
appropriate. When TTE is technically inadequate, Transesophageal Echocardiography
(TEE) may be the preferred method of evaluation. (See CV-007 for Part B providers)
8. Acute Endocarditis
TTE can provide diagnostic information; larger vegetation may be directly visualized,
valvular anatomy and ventricular function directly assessed. The complications or
sequelae of acute infective endocarditis can be detected and monitored over time.
Acutely, examination frequency is dictated by the individual clinical course. When the
acute process has been stabilized, the frequency of serial TTE evaluation will be dictated
by the residual pathophysiology and discrete clinical events; analogous to the serial
assessment of chronic valvular dysfunction and/or normally functioning prosthetic valves. (vide supra) When TTE does not document the endocarditis, TEE may define the vegetative masses more completely. (See policy CV-007 for Part B providers)
9. Pericardial Disease
Detection and quantitation of the amount of pericardial effusion were among the first and
remain important applications of TTE. Pericardial fluid accumulations of as little as twenty (20) milliliters have been reliably diagnosed by TTE. Cardiac motion and blood flow patterns demonstrated by TTE characterize the hemodynamic consequences of pericardial fluid accumulation. A collage of TTE findings has been found to be a reliable index of cardiac tamponade. TTE can be a valuable adjunct during the removal of pericardial fluid and creation of pericardial windows by balloon techniques. Acutely, clinical status will dictate examination frequency. Absent acute pathophysiology, serial assessment of chronic stable pericardial effusion by TTE is not usually medically necessary. TTE is less reliable in the detection of chronic pericardial constriction.
10. Aortic Pathology
TTE can provide valuable information when acute or chronic aortic pathology is present.
However, the posterior window of TEE, coupled with the more posterior position of the
thoracic aorta has rendered TEE a more determinative study. Noninvasive TTE remains
the study of choice for following chronic aortic pathology when images suitable for serial
quantitation can be obtained. Repetition frequency should be guided by the pathophysiologic milieu. In some individuals, such as those with Marfan's disease or atherosclerotic aneurysms, a focused limited follow-up exam (93308) to serially measure aortic diameters and arch diameters may be appropriate.
11. Congenital Heart Disease
In children and small adults TTE provides accurate anatomic definition of most
congenital heart diseases. Coupled with Doppler hemodynamic measurements, TTE
usually provides accurate diagnosis and noninvasive serial assessment. A technically
adequate TTE can obviate the need for preoperative catheterization in select individuals. *When the disease process and therapy are stable, serial assessment by TTE requires contemporaneous medical necessity documentation, if the frequency exceeds an annual evaluation. In asymptomatic patients following repair of ASD, PFO, VSD or PDA, follow-up examination is only indicated within the first year following correction.
12. Suspected Cardiac Thrombi and Embolic Sources
TTE is sensitive in the detection of ventricular thrombi and potentially embolic material.
Limited visualization of atrial interstices and the more peripheral and superior portions of
the atria render TTE less sensitive than TEE in the detection of atrial thrombus and
potentially embolic material. In individuals with cardiac pathology associated with a
high incidence of thromboemboli (valvular heart disease, arrhythmias - especially atrial
fibrillation, cardiomyopathies and ventricular dysfunction) TTE usually provides
adequate supplemental therapeutic decisional data. 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. Absent the definition
of, and serial assessment for regression of, potentially embolic material, repeat
examinations are not generally medically required to direct clinical decisions.
13. Cardiac Tumors and Masses
Infiltrative and ventricular tumors and masses can be visualized, their extent quantitated
and their hemodynamic consequences assessed by TTE. Right atrial space-occupying
masses are usually well visualized by TTE. TEE provides a more detailed view of the
left atrium and is more sensitive in quantifying mass characteristics (solid, cystic, etc.)
extensions and attachments. These acute pathologies are not generally followed serially,
except in patients with a familial history of multiple myxoma, involving the ventricles.
14. Critically Ill and Trauma Patients
There is a role for echocardiography in the management of critically ill patients and
trauma victims. The diagnosis of suspect aortic or central pulmonary pathology, cardiac
contusion, or a pericardial effusion may be confirmed. Perturbations of volume status
may be more completely defined and management strategies modified. The frequency of
these typically acute studies will be dictated by the exigencies of the clinic milieu.
15. Arrhythmia and Palpitation
TTE is useful in defining cardiac function in which arrhythmias occur, and may be useful
in the management of cardiac arrhythmias. Some arrhythmias are frequently associated
with underlying organic heart disease and may predispose the patient to hemodynamic
deterioration. Atrial fibrillation and atrial flutter are examples of arrhythmias in which
TTE may be appropriate to assess the underlying disorder. Palpitations without evidence
of arrhythmia, or minor arrhythmia without evidence of heart disease would not be
considered medically necessary indications for TTE.
16. Syncope
Determination of the etiology of a syncopal episode can be a difficult clinical problem.
The origin may be cardiac, neurological, or due to other causes. Syncope due to cardiac
origin is most commonly related to vasodepressor reflexes, bradyarrhythmias or
tachyarrhythmias. Syncope is less commonly caused by cardiac structural defects.
Patients with structurally normal heart generally have a much more benign prognosis than
those with underlying coronary artery disease or cardiomyopathic disease.
17. Pulmonary Heart Disease
Pulmonary heart disease may result from acute changes in pulmonary circulation (e.g.,
pulmonary embolus) or chronic changes produced by chronic hypoxia causing significant
right ventricular dysfunction and hypertrophy. TTE may assess right ventricular size,
performance and quantify the severity of pulmonary hypertension using doppler
examination of valvular flow signals. Indications include unexplained pulmonary
hypertension and pulmonary emboli with suspected emboli in the right atrium or
ventricle.
18. Preoperative Diagnostic Tests
Tests preformed to determine a patient's perioperative risk and optimize perioperative
care may be covered. Preoperative diagnostic tests are payable if they are medically
necessary and meet any other applicable requirements.
19. Brand Names of Contrast Agents
The following is a list of currently registered trade names for the contrast agents
addressed in this LCD:
Q9955 Perflexanelipid micropheres (Imagent®)
Q9956 Octafluoropropane (Optison®)
Q9957 Perflutren Lipid Micropheres (Definity®)
20. Contrast Echocardiography
Contrast echocardiography is indicated when a conventional study has failed to provide adequate and critically needed information on left ventricular function. A contrast agent is considered medically necessary when it is used to improve the delineation of left ventricular endocardial borders in a patient whose non-contrast study is inadequate or suboptimal, and for whom the LV function is essential to the management of the patient. Contrast is indicated when more than two (2) contiguous segments of the left ventricular border are not visualized.
The proximal great vessels and the pericardium can also be directly visualized.
The plethora of structural and functional information provided by TTE is unique among diagnostic testing modalities. The rapid and noninvasive acquisition of this information has contributed to exponential application; and to potential over-utilization. This policy addresses the medical necessity and reasonable application of TTE. Transesophageal echocardiography (TEE) and intraoperative transesophageal echocardiography is the subject of a separate policy statement. (See WPS LCD CV-007).
Echocardiography is indicated in the evaluation of derangement of valvular, myocardial and pericardial function. The applications for general coverage include:
1. Ventricular Function and Cardiomyopathies
Changes in myocardial thickness (hypertrophy and thinning) in derived parameters of
contractility, and in chamber volume and morphology can be quantitated and charted
over time by TTE. Cardiac responses to volume perturbations, chronic pressure excess
and therapeutic interventions can be monitored. Recognition of the relative contributions
of myocardial and valvular functional perturbations to clinical presentation is facilitated.
TTE aids the recognition of myopathies and their classification into hypertrophic, dilated
and restrictive types. Absent clinically documented, discrete (abrupt change in signs and
symptoms) episodes of deterioration, it is not generally medically necessary to augment
clinical assessments with TTE measurements at more frequent than annual examinations.
Although TTE is used in the assessment of ventricular diastolic function, reproducible
pathognomonic findings are not well established. In individuals with signs and/or
symptoms suggestive of ventricular dysfunction, the demonstration by TTE of normal
systolic function and/or ventricular hypertrophy may suggest the presence of diastolic
functional abnormalities
2. Hypertensive Cardiovascular Disease
Left ventricular hypertrophy (LVH) correlates with prognosis in hypertensive
cardiovascular disease. Certain antihypertensive medications have been reported to
stabilize and possibly contribute to the regression of left ventricular hypertrophy and the
insidiously progressive development of left ventricular dysfunction and dilatation. In
young individuals and in individuals with borderline hypertension, the decision to
commit to long-term antihypertensive therapy may be determined by the presence of left
ventricular hypertrophy. TTE may assist in the decision to treat through analysis and the
formulation of a treatment program. Baseline TTE and periodic serial assessment (no
more frequently than annually) would be medically appropriate. More frequent
assessment should have explicit contemporaneous medical necessity documentation.
3. Acute Myocardial Infarction and Coronary Insufficiency
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 (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. Following an initial TTE in the setting of acute infarction, repetition
frequency will typically be dictated by the acute clinical course. Absent clinical
deterioration or unclear examination findings, repeat assessment typically includes an
evaluation at discharge. Convalescent evaluation, at approximately six (6) months and
annually thereafter, generally provides adequate supplemental data to a thoughtful
clinical evaluation. The medical record should document the medical necessity of more
frequent TTE assessment.
4. Exposure to Cardiotoxic Agents (chemotherapeutic and external)
Measures of myocardial contractility, thinning and dilation are important in the titration
of therapeutic agents with known myocardial toxicity. Baseline assessment, bimonthly
during and at six (6) months following therapy is generally considered medically
appropriate. Following accidental exposure to known myocardial toxic agents, absent
abrupt change in clinical signs and/or symptoms, typically annual assessment would be
considered medically necessary.
5. Cardiac Transplant and Rejection Monitoring
TTE is an integral part of the cardiac donor selection and donor-recipient matching
process. Evaluations focus on analysis of ventricular function and valvular integrity.
TTE is also incorporated into the management of allograft recipients. Myocardial
thickness, refractile properties, contractile patterns and indices, restrictive
hemodynamics, and the late development of pericardial fluid may alert to a rejection
episode. None of these findings has achieved diagnostic sensitivity or specificity.
Typically, TTE is performed weekly for the first four-to-eight (4-8) weeks following
transplant, with decremental frequency over time. Absent acute rejection episodes,
approximately two (2) TTE examinations are typically performed yearly in chronic
transplant recipients. TTE of cardiac allografts is most appropriately serially performed
at transplant centers by examiners with expertise in the management of cardiac allograft
recipients. Use in excess of the generally accepted frequency will require appropriate
medical necessity documentation.
6. Native Valvular Heart Disease
Detection of mitral stenosis was among the first practical clinical applications of TTE.
TTE is well established as a technique of primary choice for the evaluation of valvular
pathology and its effect upon global myocardial function. The relative severity of multivalve
pathologies can be quantified. Visualization of the valve and valvular apparatus
facilitates therapeutic decisions when competing therapeutic options exist, especially
interventions for mitral stenosis. Absent acute intervention, or a discrete change in
otherwise stable clinical signs and symptoms, TTE in chronic valvular disease is used to
document course over time. Generally, it is not medically necessary to repeat these
examinations more frequently than bi-annually.
7. Prosthetic Heart Valves (Mechanical and Bio-prostheses)
TTE assessment soon after prosthetic valve implant is important in establishing a baseline
structural and hemodynamic profile unique to the individual and the prosthesis. Size,
position, underlying ventricular function and concomitant valve pathologies all impact
this unique profile. Reassessment following convalescence (3-6 months) is appropriate.
Thereafter, absent discretely defined clinical events or obvious change in physical
examination findings, annual stability assessment is considered medically reasonable and
appropriate. When TTE is technically inadequate, Transesophageal Echocardiography
(TEE) may be the preferred method of evaluation. (See CV-007 for Part B providers)
8. Acute Endocarditis
TTE can provide diagnostic information; larger vegetation may be directly visualized,
valvular anatomy and ventricular function directly assessed. The complications or
sequelae of acute infective endocarditis can be detected and monitored over time.
Acutely, examination frequency is dictated by the individual clinical course. When the
acute process has been stabilized, the frequency of serial TTE evaluation will be dictated
by the residual pathophysiology and discrete clinical events; analogous to the serial
assessment of chronic valvular dysfunction and/or normally functioning prosthetic valves. (vide supra) When TTE does not document the endocarditis, TEE may define the vegetative masses more completely. (See policy CV-007 for Part B providers)
9. Pericardial Disease
Detection and quantitation of the amount of pericardial effusion were among the first and
remain important applications of TTE. Pericardial fluid accumulations of as little as twenty (20) milliliters have been reliably diagnosed by TTE. Cardiac motion and blood flow patterns demonstrated by TTE characterize the hemodynamic consequences of pericardial fluid accumulation. A collage of TTE findings has been found to be a reliable index of cardiac tamponade. TTE can be a valuable adjunct during the removal of pericardial fluid and creation of pericardial windows by balloon techniques. Acutely, clinical status will dictate examination frequency. Absent acute pathophysiology, serial assessment of chronic stable pericardial effusion by TTE is not usually medically necessary. TTE is less reliable in the detection of chronic pericardial constriction.
10. Aortic Pathology
TTE can provide valuable information when acute or chronic aortic pathology is present.
However, the posterior window of TEE, coupled with the more posterior position of the
thoracic aorta has rendered TEE a more determinative study. Noninvasive TTE remains
the study of choice for following chronic aortic pathology when images suitable for serial
quantitation can be obtained. Repetition frequency should be guided by the pathophysiologic milieu. In some individuals, such as those with Marfan's disease or atherosclerotic aneurysms, a focused limited follow-up exam (93308) to serially measure aortic diameters and arch diameters may be appropriate.
11. Congenital Heart Disease
In children and small adults TTE provides accurate anatomic definition of most
congenital heart diseases. Coupled with Doppler hemodynamic measurements, TTE
usually provides accurate diagnosis and noninvasive serial assessment. A technically
adequate TTE can obviate the need for preoperative catheterization in select individuals. *When the disease process and therapy are stable, serial assessment by TTE requires contemporaneous medical necessity documentation, if the frequency exceeds an annual evaluation. In asymptomatic patients following repair of ASD, PFO, VSD or PDA, follow-up examination is only indicated within the first year following correction.
12. Suspected Cardiac Thrombi and Embolic Sources
TTE is sensitive in the detection of ventricular thrombi and potentially embolic material.
Limited visualization of atrial interstices and the more peripheral and superior portions of
the atria render TTE less sensitive than TEE in the detection of atrial thrombus and
potentially embolic material. In individuals with cardiac pathology associated with a
high incidence of thromboemboli (valvular heart disease, arrhythmias - especially atrial
fibrillation, cardiomyopathies and ventricular dysfunction) TTE usually provides
adequate supplemental therapeutic decisional data. 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. Absent the definition
of, and serial assessment for regression of, potentially embolic material, repeat
examinations are not generally medically required to direct clinical decisions.
13. Cardiac Tumors and Masses
Infiltrative and ventricular tumors and masses can be visualized, their extent quantitated
and their hemodynamic consequences assessed by TTE. Right atrial space-occupying
masses are usually well visualized by TTE. TEE provides a more detailed view of the
left atrium and is more sensitive in quantifying mass characteristics (solid, cystic, etc.)
extensions and attachments. These acute pathologies are not generally followed serially,
except in patients with a familial history of multiple myxoma, involving the ventricles.
14. Critically Ill and Trauma Patients
There is a role for echocardiography in the management of critically ill patients and
trauma victims. The diagnosis of suspect aortic or central pulmonary pathology, cardiac
contusion, or a pericardial effusion may be confirmed. Perturbations of volume status
may be more completely defined and management strategies modified. The frequency of
these typically acute studies will be dictated by the exigencies of the clinic milieu.
15. Arrhythmia and Palpitation
TTE is useful in defining cardiac function in which arrhythmias occur, and may be useful
in the management of cardiac arrhythmias. Some arrhythmias are frequently associated
with underlying organic heart disease and may predispose the patient to hemodynamic
deterioration. Atrial fibrillation and atrial flutter are examples of arrhythmias in which
TTE may be appropriate to assess the underlying disorder. Palpitations without evidence
of arrhythmia, or minor arrhythmia without evidence of heart disease would not be
considered medically necessary indications for TTE.
16. Syncope
Determination of the etiology of a syncopal episode can be a difficult clinical problem.
The origin may be cardiac, neurological, or due to other causes. Syncope due to cardiac
origin is most commonly related to vasodepressor reflexes, bradyarrhythmias or
tachyarrhythmias. Syncope is less commonly caused by cardiac structural defects.
Patients with structurally normal heart generally have a much more benign prognosis than
those with underlying coronary artery disease or cardiomyopathic disease.
17. Pulmonary Heart Disease
Pulmonary heart disease may result from acute changes in pulmonary circulation (e.g.,
pulmonary embolus) or chronic changes produced by chronic hypoxia causing significant
right ventricular dysfunction and hypertrophy. TTE may assess right ventricular size,
performance and quantify the severity of pulmonary hypertension using doppler
examination of valvular flow signals. Indications include unexplained pulmonary
hypertension and pulmonary emboli with suspected emboli in the right atrium or
ventricle.
18. Preoperative Diagnostic Tests
Tests preformed to determine a patient's perioperative risk and optimize perioperative
care may be covered. Preoperative diagnostic tests are payable if they are medically
necessary and meet any other applicable requirements.
19. Brand Names of Contrast Agents
The following is a list of currently registered trade names for the contrast agents
addressed in this LCD:
Q9955 Perflexanelipid micropheres (Imagent®)
Q9956 Octafluoropropane (Optison®)
Q9957 Perflutren Lipid Micropheres (Definity®)
20. Contrast Echocardiography
Contrast echocardiography is indicated when a conventional study has failed to provide adequate and critically needed information on left ventricular function. A contrast agent is considered medically necessary when it is used to improve the delineation of left ventricular endocardial borders in a patient whose non-contrast study is inadequate or suboptimal, and for whom the LV function is essential to the management of the patient. Contrast is indicated when more than two (2) contiguous segments of the left ventricular border are not visualized.
Coding Information
Bill Type Codes:
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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 021x | Skilled Nursing - Inpatient (Including Medicare Part A) |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 085x | Critical Access Hospital |
Revenue Codes:
Revenue codes 096X, 097X and 098X are to be used only by Critical Access Hospitals (CAHs) choosing the optional payment method (also called Option 2 or Method 2) and only for services performed by physicians or practitioners who have reassigned their billing rights. When a CAH has selected the optional payment method, physicians or other practitioners providing professional services at the CAH may elect to bill their carrier or assign their billing rights to the CAH. When professional services are reassigned to the CAH, the CAH must bill the FI using revenue codes 096X, 097X or 098X
CPT/HCPCS Codes
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 policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
For dates of service on or after July 1, 2006, the following revenue codes should be used when billing for RHC or FQHC services, other than those services subject to the Medicare outpatient mental health treatment limitation or for the FQHC supplement payment: 0521, 0522, 0524, 0525, 0527 and 0528. (See CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 100.)Revenue codes 096X, 097X and 098X are to be used only by Critical Access Hospitals (CAHs) choosing the optional payment method (also called Option 2 or Method 2) and only for services performed by physicians or practitioners who have reassigned their billing rights. When a CAH has selected the optional payment method, physicians or other practitioners providing professional services at the CAH may elect to bill their carrier or assign their billing rights to the CAH. When professional services are reassigned to the CAH, the CAH must bill the FI using revenue codes 096X, 097X or 098X
| 0480 | Cardiology - General Classification |
| 0483 | Cardiology - Echocardiology |
| 0521 | Free-Standing Clinic - Clinic Visit by Member to RHC/FQHC |
| 0522 | Free-Standing Clinic - Home Visit by RHC/FQHC Practitioner |
| 0524 | Free-Standing Clinic - Visit by RHC/FQHC Practitioner to a Member in a Covered Part A Stay at SNF |
| 0525 | Free-Standing Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF (not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility |
| 0527 | Free-Standing Clinic - Visiting Nurse Service(s) to a Member's Home when in a Home Health Shortage Area |
| 0528 | Free-Standing Clinic - Visit by RHC/FQHC Practitioner to Other non-RHC/FQHC site (e.g., Scene of Accident) |
| 0960 | Professional Fees - General Classification |
| 0969 | Professional Fees - Other Professional Fee |
| 0972 | Professional Fees - Radiology - Diagnostic |
| 0982 | Professional Fees - Outpatient Services |
| 0983 | Professional Fees - Clinic |
93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351 and 93352
OPPS C Codes: C8921, C8922, C8923, C8924, C8928, C8929, and C8930
| 93303 | TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE |
| 93304 | TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY |
| 93306 | ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY |
| 93307 | ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY |
| 93308 | ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY |
| 93320 | DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); COMPLETE |
| 93321 | DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); FOLLOW-UP OR LIMITED STUDY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING) |
| 93325 | DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHY) |
| 93350 | ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT; |
| 93351 | ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT; INCLUDING PERFORMANCE OF CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, WITH PHYSICIAN SUPERVISION |
| 93352 | USE OF ECHOCARDIOGRAPHIC CONTRAST AGENT DURING STRESS ECHOCARDIOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| C8921 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE |
| C8922 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY |
| C8923 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY |
| C8924 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY |
| C8928 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT |
| C8929 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY |
| C8930 | TRANSTHORACIC ECHOCARDIOGRAPHY, WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT; INCLUDING PERFORMANCE OF CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, WITH PHYSICIAN SUPERVISION |
HCPCS Contrast Agent Codes
| A9700 | SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY |
| Q9955 | INJECTION, PERFLEXANE LIPID MICROSPHERES, PER ML |
| Q9956 | INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML |
| Q9957 | INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML |
ICD-9 Codes that Support Medical Necessity
For use with CPT codes 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351
| 038.0 - 038.9 | STREPTOCOCCAL SEPTICEMIA - UNSPECIFIED SEPTICEMIA |
| 042 | HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE |
| 074.20 - 074.23 | COXSACKIE CARDITIS UNSPECIFIED - COXSACKIE MYOCARDITIS |
| 086.0 | CHAGAS' DISEASE WITH HEART INVOLVEMENT |
| 088.81 | LYME DISEASE |
| 093.0 - 093.89 | ANEURYSM OF AORTA SPECIFIED AS SYPHILITIC - OTHER SPECIFIED CARDIOVASCULAR SYPHILIS |
| 098.83 - 098.85 | GONOCOCCAL PERICARDITIS - OTHER GONOCOCCAL HEART DISEASE |
| 112.81 | CANDIDAL ENDOCARDITIS |
| 115.03 - 115.04 | HISTOPLASMA CAPSULATUM PERICARDITIS - HISTOPLASMA CAPSULATUM ENDOCARDITIS |
| 115.13 - 115.14 | HISTOPLASMA DUBOISII PERICARDITIS - HISTOPLASMA DUBOISII ENDOCARDITIS |
| 130.3 | MYOCARDITIS DUE TO TOXOPLASMOSIS |
| 135 | SARCOIDOSIS |
| 164.1 | MALIGNANT NEOPLASM OF HEART |
| 198.89 | SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES |
| 212.7 | BENIGN NEOPLASM OF HEART |
| 238.8 | NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER SPECIFIED SITES |
| 239.89 | NEOPLASMS OF UNSPECIFIED NATURE, OTHER SPECIFIED SITES |
| 265.0 | BERIBERI |
| 271.0 | GLYCOGENOSIS |
| 275.01 - 275.09 | HEREDITARY HEMOCHROMATOSIS - OTHER DISORDERS OF IRON METABOLISM |
| 276.50 - 276.69 | VOLUME DEPLETION, UNSPECIFIED - OTHER FLUID OVERLOAD |
| 277.00 - 277.9 | CYSTIC FIBROSIS WITHOUT MECONIUM ILEUS - UNSPECIFIED DISORDER OF METABOLISM |
| 282.61 - 282.62 | HB-SS DISEASE WITHOUT CRISIS - HB-SS DISEASE WITH CRISIS |
| 334.0 | FRIEDREICH'S ATAXIA |
| 359.1 | HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY |
| 359.21 - 359.29 | MYOTONIC MUSCULAR DYSTROPHY - OTHER SPECIFIED MYOTONIC DISORDER |
| 359.4 | TOXIC MYOPATHY |
| 362.31 - 362.34 | CENTRAL RETINAL ARTERY OCCLUSION - TRANSIENT RETINAL ARTERIAL OCCLUSION |
| 390 - 398.99 | RHEUMATIC FEVER WITHOUT HEART INVOLVEMENT - OTHER RHEUMATIC HEART DISEASES |
| 401.0 - 401.9 | MALIGNANT ESSENTIAL HYPERTENSION - UNSPECIFIED ESSENTIAL HYPERTENSION |
| 402.00 - 402.91 | MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE - UNSPECIFIED HYPERTENSIVE HEART DISEASE WITH HEART FAILURE |
| 404.00 - 404.93 | HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED - HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE |
| 405.01 - 405.99 | MALIGNANT RENOVASCULAR HYPERTENSION - OTHER UNSPECIFIED SECONDARY HYPERTENSION |
| 410.00 - 410.92 | ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE |
| 411.0 - 411.89 | POSTMYOCARDIAL INFARCTION SYNDROME - OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER |
| 412 | OLD MYOCARDIAL INFARCTION |
| 413.0 - 413.9 | ANGINA DECUBITUS - OTHER AND UNSPECIFIED ANGINA PECTORIS |
| 414.00 - 414.9 | CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT - CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED |
| 415.0 - 415.19 | ACUTE COR PULMONALE - OTHER PULMONARY EMBOLISM AND INFARCTION |
| 416.0 - 416.9 | PRIMARY PULMONARY HYPERTENSION - CHRONIC PULMONARY HEART DISEASE UNSPECIFIED |
| 417.0 - 417.9 | ARTERIOVENOUS FISTULA OF PULMONARY VESSELS - UNSPECIFIED DISEASE OF PULMONARY CIRCULATION |
| 420.0 - 420.99 | ACUTE PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE - OTHER ACUTE PERICARDITIS |
| 421.0 - 421.9 | ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS - ACUTE ENDOCARDITIS UNSPECIFIED |
| 422.0 | ACUTE MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE |
| 422.90 - 422.93 | ACUTE MYOCARDITIS UNSPECIFIED - TOXIC MYOCARDITIS |
| 423.0 - 423.9 | HEMOPERICARDIUM - UNSPECIFIED DISEASE OF PERICARDIUM |
| 424.0 - 424.99 | MITRAL VALVE DISORDERS - OTHER ENDOCARDITIS VALVE UNSPECIFIED |
| 425.0 - 425.9 | ENDOMYOCARDIAL FIBROSIS - SECONDARY CARDIOMYOPATHY UNSPECIFIED |
| 426.0 - 426.9 | ATRIOVENTRICULAR BLOCK COMPLETE - CONDUCTION DISORDER UNSPECIFIED |
| 427.0 - 427.89 | PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA - OTHER SPECIFIED CARDIAC DYSRHYTHMIAS |
| 428.0 - 428.9 | CONGESTIVE HEART FAILURE UNSPECIFIED - HEART FAILURE UNSPECIFIED |
| 429.0 - 429.9 | MYOCARDITIS UNSPECIFIED - HEART DISEASE UNSPECIFIED |
| 434.00 - 434.91 | CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITH CEREBRAL INFARCTION |
| 435.0 - 435.9 | BASILAR ARTERY SYNDROME - UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA |
| 436 | ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE |
| 440.0 | ATHEROSCLEROSIS OF AORTA |
| 440.20 | ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES UNSPECIFIED |
| 440.4 | CHRONIC TOTAL OCCLUSION OF ARTERY OF THE EXTREMITIES |
| 441.00 - 441.9 | DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE - AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE |
| 444.01 - 444.9 | SADDLE EMBOLUS OF ABDOMINAL AORTA - EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY |
| 446.0 | POLYARTERITIS NODOSA |
| 446.1 | ACUTE FEBRILE MUCOCUTANEOUS LYMPH NODE SYNDROME (MCLS) |
| 446.7 | TAKAYASU'S DISEASE |
| 458.0 - 458.9 | ORTHOSTATIC HYPOTENSION - HYPOTENSION UNSPECIFIED |
| 459.2 | COMPRESSION OF VEIN |
| 518.4 | ACUTE EDEMA OF LUNG UNSPECIFIED |
| 518.51 | ACUTE RESPIRATORY FAILURE FOLLOWING TRAUMA AND SURGERY |
| 518.52 | OTHER PULMONARY INSUFFICIENCY, NOT ELSEWHERE CLASSIFIED, FOLLOWING TRAUMA AND SURGERY |
| 518.53 | ACUTE AND CHRONIC RESPIRATORY FAILURE FOLLOWING TRAUMA AND SURGERY |
| 518.6 | ALLERGIC BRONCHOPULMONARY ASPERGILLIOSIS |
| 518.7 | TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) |
| 518.82 | OTHER PULMONARY INSUFFICIENCY NOT ELSEWHERE CLASSIFIED |
| 674.80 - 674.84 | OTHER COMPLICATIONS OF PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE - OTHER COMPLICATIONS OF PUERPERIUM |
| 710.0 | SYSTEMIC LUPUS ERYTHEMATOSUS |
| 745.0 - 745.9 | COMMON TRUNCUS - UNSPECIFIED DEFECT OF SEPTAL CLOSURE |
| 746.00 - 746.9 | CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED - UNSPECIFIED CONGENITAL ANOMALY OF HEART |
| 747.0 - 747.49 | PATENT DUCTUS ARTERIOSUS - OTHER ANOMALIES OF GREAT VEINS |
| 758.0 - 758.39 | DOWN'S SYNDROME - OTHER AUTOSOMAL DELETIONS |
| 758.7 | KLINEFELTER'S SYNDROME |
| 759.3 | SITUS INVERSUS |
| 759.82 | MARFAN SYNDROME |
| 780.2 | SYNCOPE AND COLLAPSE |
| 780.4 | DIZZINESS AND GIDDINESS |
| 780.60 - 780.65 | FEVER, UNSPECIFIED - HYPOTHERMIA NOT ASSOCIATED WITH LOW ENVIRONMENTAL TEMPERATURE |
| 780.66 | FEBRILE NONHEMOLYTIC TRANSFUSION REACTION |
| 782.3 | EDEMA |
| 782.5 | CYANOSIS |
| 784.3 | APHASIA |
| 785.0 - 785.3 | TACHYCARDIA UNSPECIFIED - OTHER ABNORMAL HEART SOUNDS |
| 785.50 - 785.59 | SHOCK UNSPECIFIED - OTHER SHOCK WITHOUT TRAUMA |
| 786.00 - 786.09 | RESPIRATORY ABNORMALITY UNSPECIFIED - RESPIRATORY ABNORMALITY OTHER |
| 786.30 | HEMOPTYSIS, UNSPECIFIED |
| 786.31 | ACUTE IDIOPATHIC PULMONARY HEMORRHAGE IN INFANTS [AIPHI] |
| 786.39 | OTHER HEMOPTYSIS |
| 786.50 - 786.7 | UNSPECIFIED CHEST PAIN - ABNORMAL CHEST SOUNDS |
| 790.7 | BACTEREMIA |
| 794.31 | NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM (ECG) (EKG) |
| 794.39 | OTHER NONSPECIFIC ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM |
| 796.4 | OTHER ABNORMAL CLINICAL FINDINGS |
| 807.4 | FLAIL CHEST |
| 861.00 - 861.03 | UNSPECIFIED INJURY OF HEART WITHOUT OPEN WOUND INTO THORAX - LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS WITHOUT OPEN WOUND INTO THORAX |
| 861.10 - 861.13 | UNSPECIFIED INJURY OF HEART WITH OPEN WOUND INTO THORAX - LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS AND OPEN WOUND INTO THORAX |
| 901.0 | INJURY TO THORACIC AORTA |
| 901.2 | INJURY TO SUPERIOR VENA CAVA |
| 901.41 - 901.42 | INJURY TO PULMONARY ARTERY - INJURY TO PULMONARY VEIN |
| 958.0 | AIR EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA |
| 958.1 | FAT EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA |
| 958.4 | TRAUMATIC SHOCK |
| 960.7 | POISONING BY ANTINEOPLASTIC ANTIBIOTICS |
| 962.0 | POISONING BY ADRENAL CORTICAL STEROIDS |
| 963.1 | POISONING BY ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE DRUGS |
| 965.00 - 965.09 | POISONING BY OPIUM (ALKALOIDS) UNSPECIFIED - POISONING BY OTHER OPIATES AND RELATED NARCOTICS |
| 972.0 | POISONING BY CARDIAC RHYTHM REGULATORS |
| 980.3 | TOXIC EFFECT OF FUSEL OIL |
| 982.4 | TOXIC EFFECT OF NITROGLYCOL |
| 986 | TOXIC EFFECT OF CARBON MONOXIDE |
| 990 | EFFECTS OF RADIATION UNSPECIFIED |
| 994.0 - 994.1 | EFFECTS OF LIGHTNING - DROWNING AND NONFATAL SUBMERSION |
| 994.7 - 994.8 | ASPHYXIATION AND STRANGULATION - ELECTROCUTION AND NONFATAL EFFECTS OF ELECTRIC CURRENT |
| 995.1 | ANGIONEUROTIC EDEMA NOT ELSEWHERE CLASSIFIED |
| 995.20 | UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE |
| 995.90 - 995.94 | SYSTEMIC INFLAMMATORY RESPONSE SYNDROME UNSPECIFIED - SYSTEMIC INFLAMMATORY RESPONSE SYNDROME DUE TO NONINFECTIOUS PROCESS WITH ACUTE ORGAN DYSFUNCTION |
| 996.00 - 996.02 | MECHANICAL COMPLICATIONS OF UNSPECIFIED CARDIAC DEVICE IMPLANT AND GRAFT - MECHANICAL COMPLICATION DUE TO HEART VALVE PROSTHESIS |
| 996.04 | MECHANICAL COMPLICATION OF AUTOMATIC IMPLANTABLE CARDIAC DEFIBRILLATOR |
| 996.61 | INFECTION AND INFLAMMATORY REACTION DUE TO CARDIAC DEVICE IMPLANT AND GRAFT |
| 996.71 | OTHER COMPLICATIONS DUE TO HEART VALVE PROSTHESIS |
| 996.72 | OTHER COMPLICATIONS DUE TO OTHER CARDIAC DEVICE IMPLANT AND GRAFT |
| 996.83 - 996.84 | COMPLICATIONS OF TRANSPLANTED HEART - COMPLICATIONS OF TRANSPLANTED LUNG |
| 997.1 | CARDIAC COMPLICATIONS NOT ELSEWHERE CLASSIFIED |
| 998.00 - 998.09 | POSTOPERATIVE SHOCK, UNSPECIFIED - POSTOPERATIVE SHOCK, OTHER |
| 998.51 | INFECTED POSTOPERATIVE SEROMA |
| 998.59 | OTHER POSTOPERATIVE INFECTION |
| 999.1 | AIR EMBOLISM AS A COMPLICATION OF MEDICAL CARE NOT ELSEWHERE CLASSIFIED |
| 999.31 | OTHER AND UNSPECIFIED INFECTION DUE TO CENTRAL VENOUS CATHETER |
| 999.39 | INFECTION FOLLOWING OTHER INFUSION, INJECTION, TRANSFUSION, OR VACCINATION |
| 999.41 - 999.59 | ANAPHYLACTIC REACTION DUE TO ADMINISTRATION OF BLOOD AND BLOOD PRODUCTS - OTHER SERUM REACTION |
| V08 | ASYMPTOMATIC HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION STATUS |
| V15.1 | PERSONAL HISTORY OF SURGERY TO HEART AND GREAT VESSELS PRESENTING HAZARDS TO HEALTH |
| V42.1 - V42.3 | HEART REPLACED BY TRANSPLANT - SKIN REPLACED BY TRANSPLANT |
| V42.6 | LUNG REPLACED BY TRANSPLANT |
| V43.21 | HEART REPLACED BY HEART ASSIST DEVICE |
| V43.3 | HEART VALVE REPLACED BY OTHER MEANS |
| V45.00 - V45.09 | UNSPECIFIED CARDIAC DEVICE IN SITU - OTHER SPECIFIED CARDIAC DEVICE IN SITU |
| V47.2 | OTHER CARDIORESPIRATORY PROBLEMS |
| V58.11 | ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY |
| V58.12 | ENCOUNTER FOR IMMUNOTHERAPY FOR NEOPLASTIC CONDITION |
| V58.69 | LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS |
| V58.83 | ENCOUNTER FOR THERAPEUTIC DRUG MONITORING |
| V59.8 | DONORS OF OTHER SPECIFIED ORGAN OR TISSUE |
| V67.1 | FOLLOW-UP EXAMINATION FOLLOWING RADIOTHERAPY |
| V67.2 | FOLLOW-UP EXAMINATION FOLLOWING CHEMOTHERAPY |
| V67.51 | FOLLOW-UP EXAMINATION FOLLOWING COMPLETED TREATMENT WITH HIGH-RISK MEDICATION NOT ELSEWHERE CLASSIFIED |
| V71.7 | OBSERVATION FOR SUSPECTED CARDIOVASCULAR DISEASE |
| V72.81 | PRE-OPERATIVE CARDIOVASCULAR EXAMINATION |
| V72.83 | OTHER SPECIFIED PRE-OPERATIVE EXAMINATION |
Diagnoses that Support Medical Necessity
Diagnoses listed above.
ICD-9 Codes that DO NOT Support Medical Necessity
Any ICD-9 code not listed above.
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Diagnoses not listed above.
General Information
1. The patients
medical records must be legible, contain the relevant history, physical
findings conforming to the criteria stated in the "Indications and
Limitations of Coverage" section of this
policy, and must be made available to the Contractor on request.
2. When the initial echocardiogram was sub-optimal due to co-morbidity, report this condition using ICD-9 code 794.39.
3. When it is apparent the patient will be difficult to image due to documented co-morbidity, report this condition using ICD-9 code 796.4.
4. Training Requirements: It is not this Contractor's intention to credential providers for TTE. However, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to repetition of studies and overutilization of services. It is expected that based on their experience and/or training, that such images will be submitted for interpretation. Providers of the technical component must provide high quality images that allow proper interpretation. If the quality of the technical component is a poor quality and/or does not lead to an appropriate professional interpretation, it is not a medically necessary service and thus not payable. Similarly, providers of the professional component must provide proper interpretations, based on their experience and/or training,
Appendices
policy, and must be made available to the Contractor on request.
2. When the initial echocardiogram was sub-optimal due to co-morbidity, report this condition using ICD-9 code 794.39.
3. When it is apparent the patient will be difficult to image due to documented co-morbidity, report this condition using ICD-9 code 796.4.
4. Training Requirements: It is not this Contractor's intention to credential providers for TTE. However, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to repetition of studies and overutilization of services. It is expected that based on their experience and/or training, that such images will be submitted for interpretation. Providers of the technical component must provide high quality images that allow proper interpretation. If the quality of the technical component is a poor quality and/or does not lead to an appropriate professional interpretation, it is not a medically necessary service and thus not payable. Similarly, providers of the professional component must provide proper interpretations, based on their experience and/or training,
Utilization and
frequency standards, where applicable, are outlined in the Indications
and Limitations Section of this LCD. *Repeat echocardiographic studies
should be guided by the clinical status of the patient. Repeat studies
are appropriate to monitor changes in cardiac structure or function when
there are clinical changes in the status of the patient, or when
disease progression is otherwise suspected.
*For cardiovascular stress testing , refer to the WPS LCD entitled Cardiovascular Stress Testing (CV-004).
Other Comments
This LCD consolidates and replaces all previous policies and publications on this topic by the carrier and fiscal intermediary predecessors of Wisconsin Physician Services.
For claims submitted to the fiscal intermediary; This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated Wisconsin Physician Services (formerly Mutual of Omaha) to process their claims
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the carrier, this policy was developed in cooperation with the Carrier Advisory Committee, which includes representatives from cardiology, internal medicine, anesthesiology, surgery and all relevant medical societies
Any Carrier Advisory Committee (CAC) related information, including Start Date and End Date of Comment Period, reflects the last time this LCD passed through the Comment and Notice developmental process.
Italicized font - represents CMS national policy language/wording copied directly from CMS Manuals or CMS Transmittals. Carriers are prohibited from changing national policy language/wording. Providers, through their associations/societies, should contact CMS to request changes to national policy through the Medicare Coverage Policy Process at www.cms.gov/center/coverage.asp
*- An asterisk indicates a revision to that section of the policy.
Sources of Information and Basis for Decision
*For cardiovascular stress testing , refer to the WPS LCD entitled Cardiovascular Stress Testing (CV-004).
Other Comments
This LCD consolidates and replaces all previous policies and publications on this topic by the carrier and fiscal intermediary predecessors of Wisconsin Physician Services.
For claims submitted to the fiscal intermediary; This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated Wisconsin Physician Services (formerly Mutual of Omaha) to process their claims
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the carrier, this policy was developed in cooperation with the Carrier Advisory Committee, which includes representatives from cardiology, internal medicine, anesthesiology, surgery and all relevant medical societies
Any Carrier Advisory Committee (CAC) related information, including Start Date and End Date of Comment Period, reflects the last time this LCD passed through the Comment and Notice developmental process.
Italicized font - represents CMS national policy language/wording copied directly from CMS Manuals or CMS Transmittals. Carriers are prohibited from changing national policy language/wording. Providers, through their associations/societies, should contact CMS to request changes to national policy through the Medicare Coverage Policy Process at www.cms.gov/center/coverage.asp
*- An asterisk indicates a revision to that section of the policy.
ACC/AHA Position
Statement; Guidelines for the Clinical Application of Echocardiography;
Circulation. 1997;95: 1686-1744
ACC/AHA Position Statement, Guidelines for the Clinical Application of Echocardiography; JACC 1990; 16(7):1505-1528
ACC recommendations for ICD-9 coding for TTE
AHA Position Statement, Cardiac Transplantation: Recipient Selection, Donor Procurement, and Medical Follow-up. Circulation 1992; 86(3): 1061-1079
American Society of Echocardiography. (2002). Contrast Echocardiography: Current and Future Applications. J Am Soc Echocardiography 2000; No. 13:331-342
ASE Position Paper. Contrast Echocardiography: Current and Future Applications. Journal of the American Society of Echocardiography; April 2000
Cheitlin et al. (2003). ACC/AHA/ASE Guideline Update for the Clinical Application of Echocardiography. J Am Coll Cardiol, 2003; Vol. 42: 954-970
Come, P.Lee, R. Braunwald E. Noninvasive Methods of Cardiac Examination. in Harrison's Principles of Internal Medicine, 13th ed. (Eds. Isselbacher KJ., Braunwald E., Wilson JD., Martin JB., Fauci AS,., Kasper DL) McGraw-Hill; New York; 1994:967-970
Douglas et al. (2008). ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR Appropriateness Criteria for Transthoracic and Transesophageal Echocardiography. J Am Coll Cardiol, 2008; 51:1127-1147, doi:10.1016/j.jacc.2007.12.005
Feigenbaum H. (1992). Echocardiography In Heart Disease; A Textbook of Cardiovascular Medicine, 4th ed. (Braunweld, Ed). Saunders, Philadelphia, PA 1992:64-115
Hagan, A. DeMaria, A. (1989). Clinical Applications of Two-Dimensional Echocardiography and Cardiac Doppler; (2nd Ed). Little, Brown & Company, Boston, MA 1989
Task Force 5: Complications (of cardiac transplantation). JACC 1993;22(1):41-54
The American College of Cardiology Guide to CPT 1996, Practical Reporting of Cardiovascular Services and Procedures
MCM 15360; Transmittal 1670, June 2000. (Pub.100-4, 12, §30.4)
WPS Legacy LCD
Advisory Committee Meeting Notes
ACC/AHA Position Statement, Guidelines for the Clinical Application of Echocardiography; JACC 1990; 16(7):1505-1528
ACC recommendations for ICD-9 coding for TTE
AHA Position Statement, Cardiac Transplantation: Recipient Selection, Donor Procurement, and Medical Follow-up. Circulation 1992; 86(3): 1061-1079
American Society of Echocardiography. (2002). Contrast Echocardiography: Current and Future Applications. J Am Soc Echocardiography 2000; No. 13:331-342
ASE Position Paper. Contrast Echocardiography: Current and Future Applications. Journal of the American Society of Echocardiography; April 2000
Cheitlin et al. (2003). ACC/AHA/ASE Guideline Update for the Clinical Application of Echocardiography. J Am Coll Cardiol, 2003; Vol. 42: 954-970
Come, P.Lee, R. Braunwald E. Noninvasive Methods of Cardiac Examination. in Harrison's Principles of Internal Medicine, 13th ed. (Eds. Isselbacher KJ., Braunwald E., Wilson JD., Martin JB., Fauci AS,., Kasper DL) McGraw-Hill; New York; 1994:967-970
Douglas et al. (2008). ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR Appropriateness Criteria for Transthoracic and Transesophageal Echocardiography. J Am Coll Cardiol, 2008; 51:1127-1147, doi:10.1016/j.jacc.2007.12.005
Feigenbaum H. (1992). Echocardiography In Heart Disease; A Textbook of Cardiovascular Medicine, 4th ed. (Braunweld, Ed). Saunders, Philadelphia, PA 1992:64-115
Hagan, A. DeMaria, A. (1989). Clinical Applications of Two-Dimensional Echocardiography and Cardiac Doppler; (2nd Ed). Little, Brown & Company, Boston, MA 1989
Task Force 5: Complications (of cardiac transplantation). JACC 1993;22(1):41-54
The American College of Cardiology Guide to CPT 1996, Practical Reporting of Cardiovascular Services and Procedures
MCM 15360; Transmittal 1670, June 2000. (Pub.100-4, 12, §30.4)
WPS Legacy LCD
Meeting Date:
Wisconsin 09/26/2008
Illinois 09/17/2008
Michigan 09/24/2008
Minnesota 09/25/2008
Iowa 10/16/2008
Kansas 10/17/2008
Missouri 10/17/2008
Nebraska 10/16/2008
Start Date of Comment Period
Wisconsin 09/26/2008
Illinois 09/17/2008
Michigan 09/24/2008
Minnesota 09/25/2008
Iowa 10/16/2008
Kansas 10/17/2008
Missouri 10/17/2008
Nebraska 10/16/2008
10/18/2008
End Date of Comment Period
12/03/2008
Start Date of Notice Period
02/01/2009
Revision History Number
X
Revision History Explanation
10/01/2009, ICD-9 2010 update, effective 10/01/2009, (three).
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
08/01/2009, Article published. Revised LCD to include new for 2009 CPT codes 93351 and 93352, required to assure payment of contrast agents. Valid for DOS 01/01/2009 onward. Under Indications and Limitations section, for the purpose of clarification, revised statement number 11 and add statement number 20. Under Utilization Guidelines added statement, for the purpose of clarification, to paragraph one. Removed requirement that ICD-9 code 794.39 or 796.4 be submitted when a contrast agent is used. Inclusion of OPPS C codes designated for transthoracic echocardiography procedures. Effective 03/25/2009 (two);
*06/01/2009, Clarification of instructions for use of Q6655, Q9956, Q9957 and A9700 (one)
added MAC J5 states
*01/01/2009: As a result of 2009 CPT/HCPCS coding updates, new for 2009 CPT code 93306 is included in this LCD. This code was previously addressed in other WPS versions of this LCD as CPT code 93307. Therefore, inclusion of CPT code 93306 does not establish any new indications within this LCD, nor restrict the current coverage.
08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.
8/10/2009 - The description for Revenue code 0521 was changed
8/10/2009 - The description for Revenue code 0522 was changed
09/08/2009 Sent to approved due to ICD-9 2008-2009 Annual Update.
01/17/2010 - The description for CPT/HCPCS code C8923 was changed in group 1
01/17/2010 - The description for CPT/HCPCS code C8924 was changed in group 1
01/17/2010 - The description for CPT/HCPCS code C8928 was changed in group 1
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010-In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 21 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0480 was changed
8/1/2010 - The description for Revenue code 0483 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0960 was changed
8/1/2010 - The description for Revenue code 0969 was changed
8/1/2010 - The description for Revenue code 0972 was changed
8/1/2010 - The description for Revenue code 0982 was changed
8/1/2010 - The description for Revenue code 0983 was changed
09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update.
*10/01/2010: ICD-9 2011 coding update. Effective 10/01/2010 (four).
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
93306 descriptor was changed in Group 1
93307 descriptor was changed in Group 1
93308 descriptor was changed in Group 1
93320 descriptor was changed in Group 1
93321 descriptor was changed in Group 1
C8928 descriptor was changed in Group 1
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011: ICD-9CM 2012 coding update; Added 414.4 to 414.00-414. 9 range; 415.13 to 415.0-415.19 range; 425.11 and 425.18 to 425.0-425.9 range; 444.0, in range 444.0-444.9, truncated, addition of 444.00 and 444.09; 518.5 truncated, addition of 518.51, 518.52, 518.53; 747.3, in range 747.0-747.49, truncated, addition of 747.31, 747.32 and 747.39; 998.0truncated, addition of 998.00, 998.01, 998.02 and 998.09; 999.4 truncated, addition of 999.41, 999.42 and 999.49; addition of new for 2012 999.51, 999.52 and 999.59. For use with CPT codes 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350 and 93351, effective 10/01/2011 (five).
Reason for Change
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
08/01/2009, Article published. Revised LCD to include new for 2009 CPT codes 93351 and 93352, required to assure payment of contrast agents. Valid for DOS 01/01/2009 onward. Under Indications and Limitations section, for the purpose of clarification, revised statement number 11 and add statement number 20. Under Utilization Guidelines added statement, for the purpose of clarification, to paragraph one. Removed requirement that ICD-9 code 794.39 or 796.4 be submitted when a contrast agent is used. Inclusion of OPPS C codes designated for transthoracic echocardiography procedures. Effective 03/25/2009 (two);
*06/01/2009, Clarification of instructions for use of Q6655, Q9956, Q9957 and A9700 (one)
added MAC J5 states
*01/01/2009: As a result of 2009 CPT/HCPCS coding updates, new for 2009 CPT code 93306 is included in this LCD. This code was previously addressed in other WPS versions of this LCD as CPT code 93307. Therefore, inclusion of CPT code 93306 does not establish any new indications within this LCD, nor restrict the current coverage.
08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.
8/10/2009 - The description for Revenue code 0521 was changed
8/10/2009 - The description for Revenue code 0522 was changed
09/08/2009 Sent to approved due to ICD-9 2008-2009 Annual Update.
01/17/2010 - The description for CPT/HCPCS code C8923 was changed in group 1
01/17/2010 - The description for CPT/HCPCS code C8924 was changed in group 1
01/17/2010 - The description for CPT/HCPCS code C8928 was changed in group 1
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010-In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 21 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0480 was changed
8/1/2010 - The description for Revenue code 0483 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0960 was changed
8/1/2010 - The description for Revenue code 0969 was changed
8/1/2010 - The description for Revenue code 0972 was changed
8/1/2010 - The description for Revenue code 0982 was changed
8/1/2010 - The description for Revenue code 0983 was changed
09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update.
*10/01/2010: ICD-9 2011 coding update. Effective 10/01/2010 (four).
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
93306 descriptor was changed in Group 1
93307 descriptor was changed in Group 1
93308 descriptor was changed in Group 1
93320 descriptor was changed in Group 1
93321 descriptor was changed in Group 1
C8928 descriptor was changed in Group 1
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011: ICD-9CM 2012 coding update; Added 414.4 to 414.00-414. 9 range; 415.13 to 415.0-415.19 range; 425.11 and 425.18 to 425.0-425.9 range; 444.0, in range 444.0-444.9, truncated, addition of 444.00 and 444.09; 518.5 truncated, addition of 518.51, 518.52, 518.53; 747.3, in range 747.0-747.49, truncated, addition of 747.31, 747.32 and 747.39; 998.0truncated, addition of 998.00, 998.01, 998.02 and 998.09; 999.4 truncated, addition of 999.41, 999.42 and 999.49; addition of new for 2012 999.51, 999.52 and 999.59. For use with CPT codes 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350 and 93351, effective 10/01/2011 (five).
This LCD has no Related Documents.
LCD Attachments
Coding and Billing Guidelines 10/01/2010 (PDF - 17 KB )
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Page Last Updated: Tuesday, 04-Oct-2011 15:44:20 CDT
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