L29294 TRANSESOPHAGEAL ECHOCARDIOGRAM

 

 

10/01/2011

 

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Medicare will consider transesophageal echocardiogram to be medically necessary in any of the following circumstances (see Covered ICD-9 Codes):

• Examination of prosthetic heart valves, primarily mitral

• Detection of:

o aortic dissection

o atrial septal defect

o congenital heart disease

o embolism or thrombosis, primarily involving left atrium

o intracardiac foreign bodies, tumors or masses

o mitral valve regurgitation

o vegetative endocarditis

• Intra-operative guide to left ventricular function

• Inadequacy of transthoracic echo due to:

o chest wall deformity, COPD

o open heart or chest surgery

o chest trauma

o obesity

 

 

CPT/HCPCS Codes

 

93312 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT

 

93313 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY

 

93314 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); IMAGE ACQUISITION, INTERPRETATION AND REPORT ONLY

 

93315 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT

 

93316 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY

 

93317 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; IMAGE ACQUISITION, INTERPRETATION AND REPORT ONLY

 

93318 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL (TEE) FOR MONITORING PURPOSES, INCLUDING PROBE PLACEMENT, REAL TIME 2-DIMENSIONAL IMAGE ACQUISITION AND INTERPRETATION LEADING TO ONGOING (CONTINUOUS) ASSESSMENT OF (DYNAMICALLY CHANGING) CARDIAC PUMPING FUNCTION AND TO THERAPEUTIC MEASURES ON AN IMMEDIATE TIME BASIS

 

 

ICD-9 Codes that Support Medical Necessity

 

164.1 MALIGNANT NEOPLASM OF HEART

212.7 BENIGN NEOPLASM OF HEART

278.00 OBESITY UNSPECIFIED

278.01 MORBID OBESITY

278.02 OVERWEIGHT

278.03 OBESITY HYPOVENTILATION SYNDROME

391.0 ACUTE RHEUMATIC PERICARDITIS

391.1 ACUTE RHEUMATIC ENDOCARDITIS

391.2 ACUTE RHEUMATIC MYOCARDITIS

391.8 OTHER ACUTE RHEUMATIC HEART DISEASE

391.9 ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED

394.0 MITRAL STENOSIS

394.1 RHEUMATIC MITRAL INSUFFICIENCY

394.2 MITRAL STENOSIS WITH INSUFFICIENCY

394.9 OTHER AND UNSPECIFIED MITRAL VALVE DISEASES

395.0 RHEUMATIC AORTIC STENOSIS

395.1 RHEUMATIC AORTIC INSUFFICIENCY

395.2 RHEUMATIC AORTIC STENOSIS WITH INSUFFICIENCY

395.9 OTHER AND UNSPECIFIED RHEUMATIC AORTIC DISEASES

396.0 MITRAL VALVE STENOSIS AND AORTIC VALVE STENOSIS

396.1 MITRAL VALVE STENOSIS AND AORTIC VALVE INSUFFICIENCY

396.2 MITRAL VALVE INSUFFICIENCY AND AORTIC VALVE STENOSIS

396.3 MITRAL VALVE INSUFFICIENCY AND AORTIC VALVE INSUFFICIENCY

396.8 MULTIPLE INVOLVEMENT OF MITRAL AND AORTIC VALVES

396.9 MITRAL AND AORTIC VALVE DISEASES UNSPECIFIED

397.0 DISEASES OF TRICUSPID VALVE

397.1 RHEUMATIC DISEASES OF PULMONARY VALVE

397.9 RHEUMATIC DISEASES OF ENDOCARDIUM VALVE UNSPECIFIED

410.00 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED

410.01 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL INITIAL EPISODE OF CARE

410.02 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.10 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED

410.11 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL INITIAL EPISODE OF CARE

410.12 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.20 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED

410.21 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL INITIAL EPISODE OF CARE

410.22 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.30 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED

410.31 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL INITIAL EPISODE OF CARE

410.32 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.40 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED

410.41 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL INITIAL EPISODE OF CARE

410.42 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE

410.50 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED

410.51 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL INITIAL EPISODE OF CARE

410.52 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE

410.60 TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED

410.61 TRUE POSTERIOR WALL INFARCTION INITIAL EPISODE OF CARE

410.62 TRUE POSTERIOR WALL INFARCTION SUBSEQUENT EPISODE OF CARE

410.70 SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED

410.71 SUBENDOCARDIAL INFARCTION INITIAL EPISODE OF CARE

410.72 SUBENDOCARDIAL INFARCTION SUBSEQUENT EPISODE OF CARE

410.80 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED

410.81 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES INITIAL EPISODE OF CARE

410.82 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE

410.90 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED

410.91 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE INITIAL EPISODE OF CARE

410.92 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE

411.0 POSTMYOCARDIAL INFARCTION SYNDROME

411.1 INTERMEDIATE CORONARY SYNDROME

411.81 ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION

411.89 OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER

414.00 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT

414.01 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY

414.02 CORONARY ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT

414.03 CORONARY ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT

414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT

414.05 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED BYPASS GRAFT

414.06 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY OF TRANSPLANTED HEART

414.07 CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART

414.10 ANEURYSM OF HEART (WALL)

414.11 ANEURYSM OF CORONARY VESSELS

414.12 DISSECTION OF CORONARY ARTERY

414.19 OTHER ANEURYSM OF HEART

414.4 CORONARY ATHEROSCLEROSIS DUE TO CALCIFIED CORONARY LESION

415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION

415.12 SEPTIC PULMONARY EMBOLISM

415.13 SADDLE EMBOLUS OF PULMONARY ARTERY

415.19 OTHER PULMONARY EMBOLISM AND INFARCTION

421.0 ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS

421.1 ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE

421.9 ACUTE ENDOCARDITIS UNSPECIFIED

423.0 HEMOPERICARDIUM

423.1 ADHESIVE PERICARDITIS

423.2 CONSTRICTIVE PERICARDITIS

423.3 CARDIAC TAMPONADE

423.8 OTHER SPECIFIED DISEASES OF PERICARDIUM

423.9 UNSPECIFIED DISEASE OF PERICARDIUM

424.0 MITRAL VALVE DISORDERS

424.1 AORTIC VALVE DISORDERS

424.2 TRICUSPID VALVE DISORDERS SPECIFIED AS NONRHEUMATIC

424.3 PULMONARY VALVE DISORDERS

424.90 ENDOCARDITIS VALVE UNSPECIFIED UNSPECIFIED CAUSE

424.91 ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE

424.99 OTHER ENDOCARDITIS VALVE UNSPECIFIED

425.0 ENDOMYOCARDIAL FIBROSIS

425.11 HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

425.18 OTHER HYPERTROPHIC CARDIOMYOPATHY

425.2 OBSCURE CARDIOMYOPATHY OF AFRICA

425.3 ENDOCARDIAL FIBROELASTOSIS

425.4 OTHER PRIMARY CARDIOMYOPATHIES

425.5 ALCOHOLIC CARDIOMYOPATHY

425.7 NUTRITIONAL AND METABOLIC CARDIOMYOPATHY

425.8 CARDIOMYOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE

425.9 SECONDARY CARDIOMYOPATHY UNSPECIFIED

429.4 FUNCTIONAL DISTURBANCES FOLLOWING CARDIAC SURGERY

429.5 RUPTURE OF CHORDAE TENDINEAE

429.6 RUPTURE OF PAPILLARY MUSCLE

429.71 CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED ACQUIRED CARDIAC SEPTAL DEFECT

434.10 CEREBRAL EMBOLISM WITHOUT CEREBRAL INFARCTION

434.11 CEREBRAL EMBOLISM WITH CEREBRAL INFARCTION

441.00 DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE

441.01 DISSECTION OF AORTA THORACIC

441.02 DISSECTION OF AORTA ABDOMINAL

441.03 DISSECTION OF AORTA THORACOABDOMINAL

444.01 SADDLE EMBOLUS OF ABDOMINAL AORTA

444.09 OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA

444.1 EMBOLISM AND THROMBOSIS OF THORACIC AORTA

444.21 ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY

444.22 ARTERIAL EMBOLISM AND THROMBOSIS OF LOWER EXTREMITY

444.81 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY

444.89 EMBOLISM AND THROMBOSIS OF OTHER ARTERY

444.9 EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY

453.2 OTHER VENOUS EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA

458.9 HYPOTENSION UNSPECIFIED

496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED

738.3 ACQUIRED DEFORMITY OF CHEST AND RIB

745.0 COMMON TRUNCUS

745.10 COMPLETE TRANSPOSITION OF GREAT VESSELS

745.11 DOUBLE OUTLET RIGHT VENTRICLE

745.12 CORRECTED TRANSPOSITION OF GREAT VESSELS

745.19 OTHER TRANSPOSITION OF GREAT VESSELS

745.2 TETRALOGY OF FALLOT

745.3 COMMON VENTRICLE

745.4 VENTRICULAR SEPTAL DEFECT

745.5 OSTIUM SECUNDUM TYPE ATRIAL SEPTAL DEFECT

745.60 ENDOCARDIAL CUSHION DEFECT UNSPECIFIED TYPE

745.61 OSTIUM PRIMUM DEFECT

745.69 OTHER ENDOCARDIAL CUSHION DEFECTS

745.7 COR BILOCULARE

745.8 OTHER BULBUS CORDIS ANOMALIES AND ANOMALIES OF CARDIAC SEPTAL CLOSURE

745.9 UNSPECIFIED DEFECT OF SEPTAL CLOSURE

746.00 CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED

746.01 ATRESIA OF PULMONARY VALVE CONGENITAL

746.02 STENOSIS OF PULMONARY VALVE CONGENITAL

746.09 OTHER CONGENITAL ANOMALIES OF PULMONARY VALVE

746.1 TRICUSPID ATRESIA AND STENOSIS CONGENITAL

746.2 EBSTEIN'S ANOMALY

746.3 CONGENITAL STENOSIS OF AORTIC VALVE

746.4 CONGENITAL INSUFFICIENCY OF AORTIC VALVE

746.5 CONGENITAL MITRAL STENOSIS

746.6 CONGENITAL MITRAL INSUFFICIENCY

746.7 HYPOPLASTIC LEFT HEART SYNDROME

746.81 SUBAORTIC STENOSIS CONGENITAL

746.82 COR TRIATRIATUM

746.83 INFUNDIBULAR PULMONIC STENOSIS CONGENITAL

746.84 CONGENITAL OBSTRUCTIVE ANOMALIES OF HEART NOT ELSEWHERE CLASSIFIED

746.85 CORONARY ARTERY ANOMALY CONGENITAL

746.86 CONGENITAL HEART BLOCK

746.87 MALPOSITION OF HEART AND CARDIAC APEX

746.89 OTHER SPECIFIED CONGENITAL ANOMALIES OF HEART

746.9 UNSPECIFIED CONGENITAL ANOMALY OF HEART

747.0 PATENT DUCTUS ARTERIOSUS

747.10 COARCTATION OF AORTA (PREDUCTAL) (POSTDUCTAL)

747.11 INTERRUPTION OF AORTIC ARCH

747.31 PULMONARY ARTERY COARCTATION AND ATRESIA

747.32 PULMONARY ARTERIOVENOUS MALFORMATION

747.39 OTHER ANOMALIES OF PULMONARY ARTERY AND PULMONARY CIRCULATION

754.81 PECTUS EXCAVATUM

754.82 PECTUS CARINATUM

754.89 OTHER SPECIFIED NONTERATOGENIC ANOMALIES

785.50 SHOCK UNSPECIFIED

785.51 CARDIOGENIC SHOCK

785.52 SEPTIC SHOCK

785.59 OTHER SHOCK WITHOUT TRAUMA

861.00 UNSPECIFIED INJURY OF HEART WITHOUT OPEN WOUND INTO THORAX

861.01 CONTUSION OF HEART WITHOUT OPEN WOUND INTO THORAX

861.02 LACERATION OF HEART WITHOUT PENETRATION OF HEART CHAMBERS OR OPEN WOUND INTO THORAX

861.03 LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS WITHOUT OPEN WOUND INTO THORAX

861.10 UNSPECIFIED INJURY OF HEART WITH OPEN WOUND INTO THORAX

861.11 CONTUSION OF HEART WITH OPEN WOUND INTO THORAX

861.12 LACERATION OF HEART WITHOUT PENETRATION OF HEART CHAMBERS WITH OPEN WOUND INTO THORAX

861.13 LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS AND OPEN WOUND INTO THORAX

996.02 MECHANICAL COMPLICATION DUE TO HEART VALVE PROSTHESIS

996.03 MECHANICAL COMPLICATION DUE TO CORONARY BYPASS GRAFT

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

V42.1* HEART REPLACED BY TRANSPLANT

V42.2* HEART VALVE REPLACED BY TRANSPLANT

V43.3* HEART VALVE REPLACED BY OTHER MEANS

* According to the ICD-9-CM book, diagnosis codes V42.1, V42.2 and V43.3 are secondary diagnosis codes and should not be billed as the primary diagnosis.

 

 

Documentation Requirements

 

• Medical record documentation maintained by the ordering/referring physician must clearly indicate the medical necessity of transesophageal echocardiography studies covered by the Medicare program.

o Also, the results of transesophageal echocardiography studies covered by the Medicare Program must be included in the patient's medical record.

• If the provider of transesophageal echocardiography studies is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician's order for the studies.

o When ordering transesophageal echocardiography studies, the ordering/referring physician must state the reason for the study in his order.

Treatment Logic

• 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 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.

 

 

Sources of Information and Basis for Decision

 

Ferri, F (2004). Ferri’s BEST TEST. A Practical Guide to Clinical Laboratory Medicine and Diagnostic Imaging. Mosby’s Inc. Retrieved from http://www.home.mdconsult.com/das/book/body/0/1245/1.html on July 29, 2005.

 

Miller, R (2005). Miller’s Anesthesia sixth edition. Elsevier, Inc. Retrieved from http://www.home.mdconsult.com/das/book/body/0/01255/1.html on July 29, 2005.

 

Rakel, R; Bope, E (2005). CONN’s Current Therapy 2005. Elsevier, Inc. Retrieved from http://www.home.mdconsult.com/das/book/body/0/1261/1.html on July 29, 2005.

 

Zipes, D; Libby, P; Bonow, R (2005). Braunwald’s Heart Disease, A Textbook of Cardiovascular Medicine, 7th edition. Elsevier, Inc. Retrieved from http://www.home.mdconsult.com/das/book/body/0/1282/1.html on July 29, 2005.

 

10/01/2011

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

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.

 

Local Coverage Determination (LCD) Transesophageal Echocardiogram (L29294)