SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Transesophageal Echocardiography (TEE)

A56809

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Superseded
To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56809
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Transesophageal Echocardiography (TEE)
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
09/07/2023
Revision Ending Date
11/15/2023
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy for L34337-Transesophageal Echocardiography (TEE).

 

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Response To Comments

Number Comment Response
1
N/A

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

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(390 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

The following diagnoses are covered for CPT codes 93312, 93313, and 93314. (When reporting add-on CPT codes 93320, 93321 and 93325, the same ICD-10-CM code should be used as that used for the base code to which it is attached):

Group 1 Codes
Code Description
A02.1 Salmonella sepsis
A18.84 Tuberculosis of heart
A22.7 Anthrax sepsis
A26.7 Erysipelothrix sepsis
A32.7 Listerial sepsis
A40.0 Sepsis due to streptococcus, group A
A40.1 Sepsis due to streptococcus, group B
A40.3 Sepsis due to Streptococcus pneumoniae
A40.8 Other streptococcal sepsis
A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus
A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus
A41.1 Sepsis due to other specified staphylococcus
A41.3 Sepsis due to Hemophilus influenzae
A41.4 Sepsis due to anaerobes
A41.50 - A41.53 Gram-negative sepsis, unspecified - Sepsis due to Serratia
A41.59 Other Gram-negative sepsis
A41.81 Sepsis due to Enterococcus
A41.89 Other specified sepsis
A41.9 Sepsis, unspecified organism
A42.7 Actinomycotic sepsis
A52.01 Syphilitic aneurysm of aorta
A52.02 Syphilitic aortitis
A54.86 Gonococcal sepsis
B37.7 Candidal sepsis
C38.0 Malignant neoplasm of heart
C45.2 Mesothelioma of pericardium
C79.89 Secondary malignant neoplasm of other specified sites
C79.9 Secondary malignant neoplasm of unspecified site
D15.1 Benign neoplasm of heart
D48.7 Neoplasm of uncertain behavior of other specified sites
D49.89 Neoplasm of unspecified behavior of other specified sites
G06.0 Intracranial abscess and granuloma
G06.1 Intraspinal abscess and granuloma
G45.0 - G45.2 Vertebro-basilar artery syndrome - Multiple and bilateral precerebral artery syndromes
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G46.0 - G46.2 Middle cerebral artery syndrome - Posterior cerebral artery syndrome
I01.1 Acute rheumatic endocarditis
I01.2 Acute rheumatic myocarditis
I02.0 Rheumatic chorea with heart involvement
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I08.0 - I08.3 Rheumatic disorders of both mitral and aortic valves - Combined rheumatic disorders of mitral, aortic and tricuspid valves
I08.8 Other rheumatic multiple valve diseases
I09.0 Rheumatic myocarditis
I09.89 Other specified rheumatic heart diseases
I09.9 Rheumatic heart disease, unspecified
I23.0 - I23.8 Hemopericardium as current complication following acute myocardial infarction - Other current complications following acute myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.82 Chronic total occlusion of coronary artery
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I28.0 Arteriovenous fistula of pulmonary vessels
I28.1 Aneurysm of pulmonary artery
I31.4 Cardiac tamponade
I33.0 Acute and subacute infective endocarditis
I34.0 - I34.2 Nonrheumatic mitral (valve) insufficiency - Nonrheumatic mitral (valve) stenosis
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I36.0 - I36.2 Nonrheumatic tricuspid (valve) stenosis - Nonrheumatic tricuspid (valve) stenosis with insufficiency
I36.8 Other nonrheumatic tricuspid valve disorders
I37.0 - I37.2 Nonrheumatic pulmonary valve stenosis - Nonrheumatic pulmonary valve stenosis with insufficiency
I37.8 Other nonrheumatic pulmonary valve disorders
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I40.0 Infective myocarditis
I42.0 - I42.8 Dilated cardiomyopathy - Other cardiomyopathies
I43 Cardiomyopathy in diseases classified elsewhere
I48.0 - I48.4 Paroxysmal atrial fibrillation - Atypical atrial flutter
I51.0 - I51.4 Cardiac septal defect, acquired - Myocarditis, unspecified
I51.7 Cardiomegaly
I51.81 Takotsubo syndrome
I51.89 Other ill-defined heart diseases
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.8 Other nontraumatic subarachnoid hemorrhage
I62.9 Nontraumatic intracranial hemorrhage, unspecified
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I66.01 - I66.03 Occlusion and stenosis of right middle cerebral artery - Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 - I66.13 Occlusion and stenosis of right anterior cerebral artery - Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 - I66.23 Occlusion and stenosis of right posterior cerebral artery - Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
I67.89 Other cerebrovascular disease
I70.0 Atherosclerosis of aorta
I71.00 Dissection of unspecified site of aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.03 Dissection of thoracoabdominal aorta
I71.11 Aneurysm of the ascending aorta, ruptured
I71.12 Aneurysm of the aortic arch, ruptured
I71.13 Aneurysm of the descending thoracic aorta, ruptured
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.51 Supraceliac aneurysm of the thoracoabdominal aorta, ruptured
I71.52 Paravisceral aneurysm of the thoracoabdominal aorta, ruptured
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I74.11 Embolism and thrombosis of thoracic aorta
I74.2 Embolism and thrombosis of arteries of the upper extremities
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I74.9 Embolism and thrombosis of unspecified artery
I75.89 Atheroembolism of other site
I76 Septic arterial embolism
I77.2 Rupture of artery
I82.220 Acute embolism and thrombosis of inferior vena cava
I82.221 Chronic embolism and thrombosis of inferior vena cava
I87.1 Compression of vein
I95.89 Other hypotension
I95.9 Hypotension, unspecified
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
K68.11 Postprocedural retroperitoneal abscess
M32.11 Endocarditis in systemic lupus erythematosus
O90.3 Peripartum cardiomyopathy
Q21.11 Secundum atrial septal defect
Q21.12 Patent foramen ovale
Q21.13 Coronary sinus atrial septal defect
Q21.14 Superior sinus venosus atrial septal defect
Q21.15 Inferior sinus venosus atrial septal defect
Q21.19 Other specified atrial septal defect
R57.0 Cardiogenic shock
R57.1 Hypovolemic shock
R57.8 Other shock
R57.9 Shock, unspecified
R65.20 Severe sepsis without septic shock
R65.21 Severe sepsis with septic shock
R78.81 Bacteremia
S25.01XA Minor laceration of thoracic aorta, initial encounter
S25.02XA Major laceration of thoracic aorta, initial encounter
S25.09XA Other specified injury of thoracic aorta, initial encounter
S25.21XA Minor laceration of superior vena cava, initial encounter
S25.22XA Major laceration of superior vena cava, initial encounter
S25.29XA Other specified injury of superior vena cava, initial encounter
S25.401A Unspecified injury of right pulmonary blood vessels, initial encounter
S25.402A Unspecified injury of left pulmonary blood vessels, initial encounter
S25.411A Minor laceration of right pulmonary blood vessels, initial encounter
S25.412A Minor laceration of left pulmonary blood vessels, initial encounter
S25.421A Major laceration of right pulmonary blood vessels, initial encounter
S25.422A Major laceration of left pulmonary blood vessels, initial encounter
S25.491A Other specified injury of right pulmonary blood vessels, initial encounter
S25.492A Other specified injury of left pulmonary blood vessels, initial encounter
S25.499A Other specified injury of unspecified pulmonary blood vessels, initial encounter
S25.91XA Laceration of unspecified blood vessel of thorax, initial encounter
S25.99XA Other specified injury of unspecified blood vessel of thorax, initial encounter
S26.01XA Contusion of heart with hemopericardium, initial encounter
S26.020A Mild laceration of heart with hemopericardium, initial encounter
S26.021A Moderate laceration of heart with hemopericardium, initial encounter
S26.022A Major laceration of heart with hemopericardium, initial encounter
S26.09XA Other injury of heart with hemopericardium, initial encounter
S26.11XA Contusion of heart without hemopericardium, initial encounter
S26.12XA Laceration of heart without hemopericardium, initial encounter
S26.19XA Other injury of heart without hemopericardium, initial encounter
S26.91XA Contusion of heart, unspecified with or without hemopericardium, initial encounter
S26.92XA Laceration of heart, unspecified with or without hemopericardium, initial encounter
S26.99XA Other injury of heart, unspecified with or without hemopericardium, initial encounter
T79.4XXA Traumatic shock, initial encounter
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T81.10XA Postprocedural shock unspecified, initial encounter
T81.11XA Postprocedural cardiogenic shock, initial encounter
T81.12XA Postprocedural septic shock, initial encounter
T81.19XA Other postprocedural shock, initial encounter
T81.40XA Infection following a procedure, unspecified, initial encounter
T81.40XD Infection following a procedure, unspecified, subsequent encounter
T81.40XS Infection following a procedure, unspecified, sequela
T81.41XA Infection following a procedure, superficial incisional surgical site, initial encounter
T81.41XD Infection following a procedure, superficial incisional surgical site, subsequent encounter
T81.41XS Infection following a procedure, superficial incisional surgical site, sequela
T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter
T81.42XD Infection following a procedure, deep incisional surgical site, subsequent encounter
T81.42XS Infection following a procedure, deep incisional surgical site, sequela
T81.43XA Infection following a procedure, organ and space surgical site, initial encounter
T81.43XD Infection following a procedure, organ and space surgical site, subsequent encounter
T81.43XS Infection following a procedure, organ and space surgical site, sequela
T81.44XA Sepsis following a procedure, initial encounter
T81.44XD Sepsis following a procedure, subsequent encounter
T81.44XS Sepsis following a procedure, sequela
T81.49XA Infection following a procedure, other surgical site, initial encounter
T81.49XD Infection following a procedure, other surgical site, subsequent encounter
T81.49XS Infection following a procedure, other surgical site, sequela
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
T82.02XA Displacement of heart valve prosthesis, initial encounter
T82.03XA Leakage of heart valve prosthesis, initial encounter
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial encounter
T82.310A Breakdown (mechanical) of aortic (bifurcation) graft (replacement), initial encounter
T82.311A Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.318A Breakdown (mechanical) of other vascular grafts, initial encounter
T82.320A Displacement of aortic (bifurcation) graft (replacement), initial encounter
T82.321A Displacement of carotid arterial graft (bypass), initial encounter
T82.322A Displacement of femoral arterial graft (bypass), initial encounter
T82.328A Displacement of other vascular grafts, initial encounter
T82.330A Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A Leakage of carotid arterial graft (bypass), initial encounter
T82.332A Leakage of femoral arterial graft (bypass), initial encounter
T82.338A Leakage of other vascular grafts, initial encounter
T82.390A Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter
T82.391A Other mechanical complication of carotid arterial graft (bypass), initial encounter
T82.392A Other mechanical complication of femoral arterial graft (bypass), initial encounter
T82.398A Other mechanical complication of other vascular grafts, initial encounter
T82.41XA Breakdown (mechanical) of vascular dialysis catheter, initial encounter
T82.42XA Displacement of vascular dialysis catheter, initial encounter
T82.43XA Leakage of vascular dialysis catheter, initial encounter
T82.510A Breakdown (mechanical) of surgically created arteriovenous fistula, initial encounter
T82.511A Breakdown (mechanical) of surgically created arteriovenous shunt, initial encounter
T82.513A Breakdown (mechanical) of balloon (counterpulsation) device, initial encounter
T82.514A Breakdown (mechanical) of infusion catheter, initial encounter
T82.515A Breakdown (mechanical) of umbrella device, initial encounter
T82.518A Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.520A Displacement of surgically created arteriovenous fistula, initial encounter
T82.521A Displacement of surgically created arteriovenous shunt, initial encounter
T82.522A Displacement of artificial heart, initial encounter
T82.523A Displacement of balloon (counterpulsation) device, initial encounter
T82.524A Displacement of infusion catheter, initial encounter
T82.525A Displacement of umbrella device, initial encounter
T82.528A Displacement of other cardiac and vascular devices and implants, initial encounter
T82.530A Leakage of surgically created arteriovenous fistula, initial encounter
T82.531A Leakage of surgically created arteriovenous shunt, initial encounter
T82.533A Leakage of balloon (counterpulsation) device, initial encounter
T82.534A Leakage of infusion catheter, initial encounter
T82.535A Leakage of umbrella device, initial encounter
T82.538A Leakage of other cardiac and vascular devices and implants, initial encounter
T82.590A Other mechanical complication of surgically created arteriovenous fistula, initial encounter
T82.591A Other mechanical complication of surgically created arteriovenous shunt, initial encounter
T82.593A Other mechanical complication of balloon (counterpulsation) device, initial encounter
T82.594A Other mechanical complication of infusion catheter, initial encounter
T82.595A Other mechanical complication of umbrella device, initial encounter
T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.6XXA Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.9XXA Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter
T84.51XA Infection and inflammatory reaction due to internal right hip prosthesis, initial encounter
T84.52XA Infection and inflammatory reaction due to internal left hip prosthesis, initial encounter
T84.53XA Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter
T84.54XA Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter
T84.59XA Infection and inflammatory reaction due to other internal joint prosthesis, initial encounter
T85.79XA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter
Z48.21 Encounter for aftercare following heart transplant
Z48.24 Encounter for aftercare following lung transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z52.89 Donor of other specified organs or tissues
Z94.1 - Z95.2 Heart transplant status - Presence of prosthetic heart valve
Z98.890 Other specified postprocedural states
Z98.891 History of uterine scar from previous surgery

Group 2

(6 Codes)
Group 2 Paragraph

Use R93.1 or R93.89 when a TEE is performed because of inadequate visualization of cardiac anatomy on TTE, for structures normally visualized by TTE and for which TEE is not usually indicated. The R93.1 or R93.89 should be coded as the primary diagnosis and the cardiac abnormality should be coded as a secondary diagnosis. The list of ICD-10 codes for this secondary diagnosis will be found in the LCD for Transthoracic Echocardiography, L34338, under the list of payable ICD-10 codes for CPT codes 93303 and 93304, and the list of payable ICD-10 codes for CPT codes 93306, 93307 and 93308.

* Use Z01.30-Z01.31, Z01.82, or Z01.89 when a TEE is performed during an open chest procedure. Z01.30-Z01.31, Z01.82, or Z01.89 should be coded as the primary diagnosis and the reason for the surgical procedure should be coded as the secondary diagnosis.

Group 2 Codes
Code Description
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.89 Abnormal findings on diagnostic imaging of other specified body structures
Z01.30 Encounter for examination of blood pressure without abnormal findings
Z01.31 Encounter for examination of blood pressure with abnormal findings
Z01.82 Encounter for allergy testing
Z01.89 Encounter for other specified special examinations

Group 3

(71 Codes)
Group 3 Paragraph

The following diagnoses are covered for CPT codes 93315, 93316, and 93317 (When reporting add-on CPT codes 93320, 93321 and 93325, the same ICD-10-CM code should be used as that used for the base code to which it is attached):

Group 3 Codes
Code Description
Q20.0 - Q20.5 Common arterial trunk - Discordant atrioventricular connection
Q20.8 Other congenital malformations of cardiac chambers and connections
Q21.0 - Q21.3 Ventricular septal defect - Tetralogy of Fallot
Q22.0 - Q22.6 Pulmonary valve atresia - Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q23.0 - Q23.4 Congenital stenosis of aortic valve - Hypoplastic left heart syndrome
Q24.2 - Q24.5 Cor triatriatum - Malformation of coronary vessels
Q24.8 Other specified congenital malformations of heart
Q25.0 Patent ductus arteriosus
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q25.3 Supravalvular aortic stenosis
Q25.41 Absence and aplasia of aorta
Q25.42 Hypoplasia of aorta
Q25.43 Congenital aneurysm of aorta
Q25.44 Congenital dilation of aorta
Q25.45 Double aortic arch
Q25.46 Tortuous aortic arch
Q25.47 Right aortic arch
Q25.48 Anomalous origin of subclavian artery
Q25.49 Other congenital malformations of aorta
Q25.5 Atresia of pulmonary artery
Q25.6 Stenosis of pulmonary artery
Q25.71 Coarctation of pulmonary artery
Q25.72 Congenital pulmonary arteriovenous malformation
Q25.79 Other congenital malformations of pulmonary artery
Q25.8 Other congenital malformations of other great arteries
Q26.0 - Q26.4 Congenital stenosis of vena cava - Anomalous pulmonary venous connection, unspecified
Q26.8 Other congenital malformations of great veins
Q26.9 Congenital malformation of great vein, unspecified
Q87.40 Marfan syndrome, unspecified
Q87.410 Marfan syndrome with aortic dilation
Q87.418 Marfan syndrome with other cardiovascular manifestations
Q87.42 Marfan syndrome with ocular manifestations
Q87.43 Marfan syndrome with skeletal manifestation

Group 4

(60 Codes)
Group 4 Paragraph

The following diagnoses are covered for CPT codes 76376 and 76377 when performed for 3-D imaging following CPT codes 93312, 93314, 93315 or 93317 (the same ICD-10-CM code should be used as that used for the base code to which it is attached):

Group 4 Codes
Code Description
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I08.0 Rheumatic disorders of both mitral and aortic valves
I08.8 Other rheumatic multiple valve diseases
I23.1 Atrial septal defect as current complication following acute myocardial infarction
I23.2 Ventricular septal defect as current complication following acute myocardial infarction
I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
I33.0 Acute and subacute infective endocarditis
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I48.0 - I48.4 Paroxysmal atrial fibrillation - Atypical atrial flutter
I51.0 - I51.2 Cardiac septal defect, acquired - Rupture of papillary muscle, not elsewhere classified
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
Q21.11 Secundum atrial septal defect
Q21.12 Patent foramen ovale
Q21.13 Coronary sinus atrial septal defect
Q21.14 Superior sinus venosus atrial septal defect
Q21.15 Inferior sinus venosus atrial septal defect
Q21.19 Other specified atrial septal defect
Q21.20 Atrioventricular septal defect, unspecified as to partial or complete
Q21.21 Partial atrioventricular septal defect
Q21.22 Transitional atrioventricular septal defect
Q21.23 Complete atrioventricular septal defect
Q23.3 Congenital mitral insufficiency
T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
T82.02XA Displacement of heart valve prosthesis, initial encounter
T82.03XA Leakage of heart valve prosthesis, initial encounter
T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
T82.519A Breakdown (mechanical) of unspecified cardiac and vascular devices and implants, initial encounter
T82.529A Displacement of unspecified cardiac and vascular devices and implants, initial encounter
T82.539A Leakage of unspecified cardiac and vascular devices and implants, initial encounter
T82.599A Other mechanical complication of unspecified cardiac and vascular devices and implants, initial encounter
T82.6XXA Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.9XXA Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter
N/A

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

Please accept the License to see the codes.

N/A

Revenue 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 article, 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 article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.


Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
09/07/2023 R7

Revision Effective: 09/07/2023

Revision Explanation: Annual review, no changes.

10/01/2022 R6

Revision Effective: 10/01/2022

Revision Explanation: Annual ICD-10 Update, removed I34.8,I71.01,I71.1,I71.2,I71.5,I71.6,Q21.1,Q21.1,Q21.2 and added to added to Group 1: I34.81, I34.89, I71.11, I71.12
I71.13, I71.21, I71.22, I71.23, I71.51, I71.52, I71.61, I71.62, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.19 . Added to Group 4 Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.19, Q21.20, Q21.21, Q21.22, and Q21.23.

10/01/2022 R5

Revision Effective: 10/01/2022 

Revision Explanation: Annual ICD-10 Update, added I71.011 and I71.012.

09/01/2022 R4

Revision Effective: 09/01/2022

Revision Explanation: Annual review, no changes were made.

08/19/2021 R3

Revision Effective: 08/19/2021

Revision Explanation: Annual review, no changes were made.

10/01/2019 R2

Revision Effective: n/a

Revision Explanation: Annual review, no changes made

10/01/2019 R1

R1

Revision Effective: 10/01/2019

Revision Explanation: During the annual ICD-10 update codes I48.1 and I48.2 were end dated and replaced with I48.11, I48.12, I48.20, and I48.21. New codes I26.93 and I26.94 were added to group 1.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34337 - Transesophageal Echocardiography (TEE)
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
08/26/2024 09/05/2024 - N/A Currently in Effect View
11/07/2023 11/16/2023 - 09/04/2024 Superseded View
08/31/2023 09/07/2023 - 11/15/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A