LCD Reference Article Billing and Coding Article

Billing and Coding: Transesophageal Echocardiogram

A57179

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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.

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General Information

Source Article ID
N/A
Article ID
A57179
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Transesophageal Echocardiogram
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
02/09/2024
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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.

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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

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33756, Transesophageal Echocardiogram. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

If the service of the cardiologist is requested for a specific reason, his professional services would be billed with CPT 93314 or 93317 with the 26 modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. 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. When ordering transesophageal echocardiography studies, the ordering/referring physician must state the reason for the study in his order.
  5. An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(11 Codes)
Group 1 Paragraph

Part A

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
93312 Echo transesophageal
93313 Echo transesophageal
93314 Echo transesophageal
93315 Echo transesophageal
93316 Echo transesophageal
93317 Echo transesophageal
93318 Echo transesophageal intraop
93355 Echo transesophageal (tee)
C8925 2d tee w or w/o fol w/con,in
C8926 Tee w or w/o fol w/cont,cong
C8927 Tee w or w/o fol w/cont, mon

Group 2

(8 Codes)
Group 2 Paragraph

Part B

Group 2 Codes
Code Description
93312 Echo transesophageal
93313 Echo transesophageal
93314 Echo transesophageal
93315 Echo transesophageal
93316 Echo transesophageal
93317 Echo transesophageal
93318 Echo transesophageal intraop
93355 Echo transesophageal (tee)
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

(412 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93355, C8925, C8926, and C8927.

Group 1 Codes
Code Description
A18.84 Tuberculosis of heart
B95.61 Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.62 Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.7 Other staphylococcus as the cause of diseases classified elsewhere
B95.8 Unspecified staphylococcus as the cause of diseases classified elsewhere
C38.0 Malignant neoplasm of heart
C45.2 Mesothelioma of pericardium
D15.1 Benign neoplasm of heart
E66.01 Morbid (severe) obesity due to excess calories
E66.09 Other obesity due to excess calories
E66.1 Drug-induced obesity
E66.2 Morbid (severe) obesity with alveolar hypoventilation
E66.3 Overweight
E66.8 Other obesity
E66.9 Obesity, unspecified
I01.0 Acute rheumatic pericarditis
I01.1 Acute rheumatic endocarditis
I01.2 Acute rheumatic myocarditis
I01.8 Other acute rheumatic heart disease
I01.9 Acute rheumatic heart disease, unspecified
I05.0 Rheumatic mitral stenosis
I05.1 Rheumatic mitral insufficiency
I05.2 Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I05.9 Rheumatic mitral valve disease, unspecified
I06.0 Rheumatic aortic stenosis
I06.1 Rheumatic aortic insufficiency
I06.2 Rheumatic aortic stenosis with insufficiency
I06.8 Other rheumatic aortic valve diseases
I06.9 Rheumatic aortic valve disease, unspecified
I07.0 Rheumatic tricuspid stenosis
I07.1 Rheumatic tricuspid insufficiency
I07.2 Rheumatic tricuspid stenosis and insufficiency
I07.8 Other rheumatic tricuspid valve diseases
I07.9 Rheumatic tricuspid valve disease, unspecified
I08.0 Rheumatic disorders of both mitral and aortic valves
I08.1 Rheumatic disorders of both mitral and tricuspid valves
I08.2 Rheumatic disorders of both aortic and tricuspid valves
I08.3 Combined rheumatic disorders of mitral, aortic and tricuspid valves
I08.8 Other rheumatic multiple valve diseases
I08.9 Rheumatic multiple valve disease, unspecified
I09.0 Rheumatic myocarditis
I09.1 Rheumatic diseases of endocardium, valve unspecified
I09.89 Other specified rheumatic heart diseases
I20.0 Unstable angina
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I21.9 Acute myocardial infarction, unspecified
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
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
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.89 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
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
I31.0 Chronic adhesive pericarditis
I31.1 Chronic constrictive pericarditis
I31.2 Hemopericardium, not elsewhere classified
I31.31 Malignant pericardial effusion in diseases classified elsewhere
I31.39 Other pericardial effusion (noninflammatory)
I31.4 Cardiac tamponade
I31.8 Other specified diseases of pericardium
I31.9 Disease of pericardium, unspecified
I33.0 Acute and subacute infective endocarditis
I33.9 Acute and subacute endocarditis, unspecified
I34.0 Nonrheumatic mitral (valve) insufficiency
I34.1 Nonrheumatic mitral (valve) prolapse
I34.2 Nonrheumatic mitral (valve) stenosis
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I34.9 Nonrheumatic mitral valve disorder, unspecified
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I36.0 Nonrheumatic tricuspid (valve) stenosis
I36.1 Nonrheumatic tricuspid (valve) insufficiency
I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency
I36.8 Other nonrheumatic tricuspid valve disorders
I36.9 Nonrheumatic tricuspid valve disorder, unspecified
I37.0 Nonrheumatic pulmonary valve stenosis
I37.1 Nonrheumatic pulmonary valve insufficiency
I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency
I37.8 Other nonrheumatic pulmonary valve disorders
I37.9 Nonrheumatic pulmonary valve disorder, unspecified
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I51.0 Cardiac septal defect, acquired
I51.1 Rupture of chordae tendineae, not elsewhere classified
I51.2 Rupture of papillary muscle, not elsewhere classified
I51.3 Intracardiac thrombosis, not elsewhere classified
I63.40 Cerebral infarction due to embolism of unspecified 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
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.419 Cerebral infarction due to embolism of unspecified 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
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.429 Cerebral infarction due to embolism of unspecified 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
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.439 Cerebral infarction due to embolism of unspecified 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
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.449 Cerebral infarction due to embolism of unspecified cerebellar artery
I63.49 Cerebral infarction due to embolism of other cerebral artery
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.09 Occlusion and stenosis of unspecified middle cerebral artery
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.19 Occlusion and stenosis of unspecified anterior cerebral artery
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.29 Occlusion and stenosis of unspecified posterior cerebral artery
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I66.9 Occlusion and stenosis of unspecified cerebral artery
I71.00 Dissection of unspecified site of aorta
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.019 Dissection of thoracic aorta, unspecified
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I74.01 Saddle embolus of abdominal aorta
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.10 Embolism and thrombosis of unspecified parts of aorta
I74.11 Embolism and thrombosis of thoracic aorta
I74.19 Embolism and thrombosis of other parts of aorta
I74.2 Embolism and thrombosis of arteries of the upper extremities
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.4 Embolism and thrombosis of arteries of extremities, unspecified
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I74.9 Embolism and thrombosis of unspecified artery
I82.220 Acute embolism and thrombosis of inferior vena cava
I82.221 Chronic embolism and thrombosis of inferior vena cava
I95.9 Hypotension, unspecified
I97.0 Postcardiotomy syndrome
J44.9 Chronic obstructive pulmonary disease, unspecified
M32.11 Endocarditis in systemic lupus erythematosus
M95.4 Acquired deformity of chest and rib
M99.82 Other biomechanical lesions of thoracic region
M99.88 Other biomechanical lesions of rib cage
Q20.0 Common arterial trunk
Q20.1 Double outlet right ventricle
Q20.2 Double outlet left ventricle
Q20.3 Discordant ventriculoarterial connection
Q20.4 Double inlet ventricle
Q20.5 Discordant atrioventricular connection
Q20.6 Isomerism of atrial appendages
Q20.8 Other congenital malformations of cardiac chambers and connections
Q20.9 Congenital malformation of cardiac chambers and connections, unspecified
Q21.0 Ventricular septal defect
Q21.10 Atrial septal defect, unspecified
Q21.11 Secundum atrial septal defect
Q21.12 Patent foramen ovale
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
Q21.3 Tetralogy of Fallot
Q21.4 Aortopulmonary septal defect
Q21.8 Other congenital malformations of cardiac septa
Q21.9 Congenital malformation of cardiac septum, unspecified
Q22.0 Pulmonary valve atresia
Q22.1 Congenital pulmonary valve stenosis
Q22.2 Congenital pulmonary valve insufficiency
Q22.3 Other congenital malformations of pulmonary valve
Q22.4 Congenital tricuspid stenosis
Q22.5 Ebstein's anomaly
Q22.6 Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q22.9 Congenital malformation of tricuspid valve, unspecified
Q23.0 Congenital stenosis of aortic valve
Q23.1 Congenital insufficiency of aortic valve
Q23.2 Congenital mitral stenosis
Q23.3 Congenital mitral insufficiency
Q23.4 Hypoplastic left heart syndrome
Q23.8 Other congenital malformations of aortic and mitral valves
Q23.9 Congenital malformation of aortic and mitral valves, unspecified
Q24.0 Dextrocardia
Q24.1 Levocardia
Q24.2 Cor triatriatum
Q24.3 Pulmonary infundibular stenosis
Q24.4 Congenital subaortic stenosis
Q24.5 Malformation of coronary vessels
Q24.6 Congenital heart block
Q24.8 Other specified congenital malformations of heart
Q24.9 Congenital malformation of heart, unspecified
Q25.0 Patent ductus arteriosus
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia 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
Q67.6 Pectus excavatum
Q67.7 Pectus carinatum
Q67.8 Other congenital deformities of chest
R57.0 Cardiogenic shock
R57.1 Hypovolemic shock
R57.8 Other shock
R57.9 Shock, unspecified
R65.21 Severe sepsis with septic shock
R78.81 Bacteremia
S21.309A Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, initial encounter
S21.309D Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, subsequent encounter
S21.309S Unspecified open wound of unspecified front wall of thorax with penetration into thoracic cavity, sequela
S26.00XA Unspecified injury of heart with hemopericardium, initial encounter
S26.00XD Unspecified injury of heart with hemopericardium, subsequent encounter
S26.00XS Unspecified injury of heart with hemopericardium, sequela
S26.01XA Contusion of heart with hemopericardium, initial encounter
S26.01XD Contusion of heart with hemopericardium, subsequent encounter
S26.01XS Contusion of heart with hemopericardium, sequela
S26.020A Mild laceration of heart with hemopericardium, initial encounter
S26.020D Mild laceration of heart with hemopericardium, subsequent encounter
S26.020S Mild laceration of heart with hemopericardium, sequela
S26.021A Moderate laceration of heart with hemopericardium, initial encounter
S26.021D Moderate laceration of heart with hemopericardium, subsequent encounter
S26.021S Moderate laceration of heart with hemopericardium, sequela
S26.022A Major laceration of heart with hemopericardium, initial encounter
S26.022D Major laceration of heart with hemopericardium, subsequent encounter
S26.022S Major laceration of heart with hemopericardium, sequela
S26.09XA Other injury of heart with hemopericardium, initial encounter
S26.09XD Other injury of heart with hemopericardium, subsequent encounter
S26.09XS Other injury of heart with hemopericardium, sequela
S26.10XA Unspecified injury of heart without hemopericardium, initial encounter
S26.10XD Unspecified injury of heart without hemopericardium, subsequent encounter
S26.10XS Unspecified injury of heart without hemopericardium, sequela
S26.11XA Contusion of heart without hemopericardium, initial encounter
S26.11XD Contusion of heart without hemopericardium, subsequent encounter
S26.11XS Contusion of heart without hemopericardium, sequela
S26.12XA Laceration of heart without hemopericardium, initial encounter
S26.12XD Laceration of heart without hemopericardium, subsequent encounter
S26.12XS Laceration of heart without hemopericardium, sequela
S26.19XA Other injury of heart without hemopericardium, initial encounter
S26.19XD Other injury of heart without hemopericardium, subsequent encounter
S26.19XS Other injury of heart without hemopericardium, sequela
S26.90XA Unspecified injury of heart, unspecified with or without hemopericardium, initial encounter
S26.90XD Unspecified injury of heart, unspecified with or without hemopericardium, subsequent encounter
S26.90XS Unspecified injury of heart, unspecified with or without hemopericardium, sequela
S26.91XA Contusion of heart, unspecified with or without hemopericardium, initial encounter
S26.91XD Contusion of heart, unspecified with or without hemopericardium, subsequent encounter
S26.91XS Contusion of heart, unspecified with or without hemopericardium, sequela
S26.92XA Laceration of heart, unspecified with or without hemopericardium, initial encounter
S26.92XD Laceration of heart, unspecified with or without hemopericardium, subsequent encounter
S26.92XS Laceration of heart, unspecified with or without hemopericardium, sequela
S26.99XA Other injury of heart, unspecified with or without hemopericardium, initial encounter
S26.99XD Other injury of heart, unspecified with or without hemopericardium, subsequent encounter
S26.99XS Other injury of heart, unspecified with or without hemopericardium, sequela
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T80.0XXD Air embolism following infusion, transfusion and therapeutic injection, subsequent encounter
T80.0XXS Air embolism following infusion, transfusion and therapeutic injection, sequela
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.718D Complication of other artery following a procedure, not elsewhere classified, subsequent encounter
T81.718S Complication of other artery following a procedure, not elsewhere classified, sequela
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T81.72XD Complication of vein following a procedure, not elsewhere classified, subsequent encounter
T81.72XS Complication of vein following a procedure, not elsewhere classified, sequela
T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
T82.01XD Breakdown (mechanical) of heart valve prosthesis, subsequent encounter
T82.01XS Breakdown (mechanical) of heart valve prosthesis, sequela
T82.02XA Displacement of heart valve prosthesis, initial encounter
T82.02XD Displacement of heart valve prosthesis, subsequent encounter
T82.02XS Displacement of heart valve prosthesis, sequela
T82.03XA Leakage of heart valve prosthesis, initial encounter
T82.03XD Leakage of heart valve prosthesis, subsequent encounter
T82.03XS Leakage of heart valve prosthesis, sequela
T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
T82.09XD Other mechanical complication of heart valve prosthesis, subsequent encounter
T82.09XS Other mechanical complication of heart valve prosthesis, sequela
T82.211A Breakdown (mechanical) of coronary artery bypass graft, initial encounter
T82.211D Breakdown (mechanical) of coronary artery bypass graft, subsequent encounter
T82.211S Breakdown (mechanical) of coronary artery bypass graft, sequela
T82.212A Displacement of coronary artery bypass graft, initial encounter
T82.212D Displacement of coronary artery bypass graft, subsequent encounter
T82.212S Displacement of coronary artery bypass graft, sequela
T82.213A Leakage of coronary artery bypass graft, initial encounter
T82.213D Leakage of coronary artery bypass graft, subsequent encounter
T82.213S Leakage of coronary artery bypass graft, sequela
T82.218A Other mechanical complication of coronary artery bypass graft, initial encounter
T82.218D Other mechanical complication of coronary artery bypass graft, subsequent encounter
T82.218S Other mechanical complication of coronary artery bypass graft, sequela
T82.6XXA Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter
T82.6XXD Infection and inflammatory reaction due to cardiac valve prosthesis, subsequent encounter
T82.6XXS Infection and inflammatory reaction due to cardiac valve prosthesis, sequela
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
T82.7XXD Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, subsequent encounter
T82.7XXS Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, sequela
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.817D Embolism due to cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.817S Embolism due to cardiac prosthetic devices, implants and grafts, sequela
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.827D Fibrosis due to cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.827S Fibrosis due to cardiac prosthetic devices, implants and grafts, sequela
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.837D Hemorrhage due to cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.837S Hemorrhage due to cardiac prosthetic devices, implants and grafts, sequela
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.847D Pain due to cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.847S Pain due to cardiac prosthetic devices, implants and grafts, sequela
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.857D Stenosis of other cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.857S Stenosis of other cardiac prosthetic devices, implants and grafts, sequela
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.867D Thrombosis due to cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.867S Thrombosis due to cardiac prosthetic devices, implants and grafts, sequela
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.897D Other specified complication of cardiac prosthetic devices, implants and grafts, subsequent encounter
T82.897S Other specified complication of cardiac prosthetic devices, implants and grafts, sequela
T82.9XXA Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter
T82.9XXD Unspecified complication of cardiac and vascular prosthetic device, implant and graft, subsequent encounter
T82.9XXS Unspecified complication of cardiac and vascular prosthetic device, implant and graft, sequela
Z48.21* Encounter for aftercare following heart transplant
Z48.280* Encounter for aftercare following heart-lung transplant
Z94.1* Heart transplant status
Z94.3* Heart and lungs transplant status
Z95.2* Presence of prosthetic heart valve
Z95.3* Presence of xenogenic heart valve
Z95.4* Presence of other heart-valve replacement
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Diagnosis codes Z48.21, Z48.280, Z94.1, Z94.3, Z95.2, Z95.3, and Z95.4 should not be billed as the primary diagnosis.

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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
999x Not Applicable
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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.

Code Description
99999 Not Applicable
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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

Revision History Date Revision History Number Revision History Explanation
02/09/2024 R3

Article revised and published on 04/11/2024 effective for dates of service on and after 02/09/2024. The following ICD-10-CM codes have been added to Group 1 Codes that Support Medical Necessity: B95.61, B95.62, B95.7, B95.8, I51.3, and R78.81. This revision is in response to an inquiry. Minor formatting changes have been made throughout the article.

10/01/2023 R2

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has been deleted and therefore removed from the article: I24.8 in Group 1 codes. The following ICD-10-CM code has been added to ‘Group 1 codes’: I24.89. Minor formatting changes have been made throughout the article.

10/01/2022 R1

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: I31.31, I31.39, I34.81, I34.89, I71.010, I71.011, I71.012, I71.019, Q21.10, Q21.11, Q21.12, Q21.19, Q21.20, Q21.21, Q21.22, and Q21.23 to the ‘Group 1 Codes’. The following ICD-10-CM codes have been deleted and therefore have been removed from the article: I31.3, I34.8, I71.01, Q21.1, and Q21.2 from the ‘Group 1 Codes’. A reference to the Social Security Act has been added to the ‘CMS National Coverage Policy’ section along with formatting changes throughout the article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33756 - Transesophageal Echocardiogram
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/05/2024 02/09/2024 - N/A Currently in Effect You are here
10/20/2023 10/01/2023 - 02/08/2024 Superseded View
10/14/2022 10/01/2022 - 09/30/2023 Superseded View
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Keywords

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