Billing and Coding: Transthoracic Echocardiography (TTE)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Transthoracic Echocardiography (TTE).

**Coding Information:**

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.

**Documentation Requirements:**

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the LCD. (See "Indications
and Limitations of Coverage.") This documentation includes, but is not limited
to, relevant medical history, physical examination, and results of pertinent
diagnostic tests or procedures, as well as reasons for repeat testing.

Each service requires a formal written report with interpretation. This report
should be kept on file with copies of image documentation (paper or tape) for
review if requested. All appropriate measurements should be included in the
report.

At a minimum, a complete study should contain M mode and/or 2D measurements of
LV end diastolic diameter, LV end systolic diameter, LV wall thickness, left
atrial diameter, aortic valve excursion and a qualitative description of the
LV function, whenever possible given any technical limitations in a particular
case. Individual echocardiographic laboratories (providers) may choose valid
substitutes for these parameters such as LV volumes, ejection fraction and
mass measurements.

A Doppler interrogation should state the modes used and should give both
qualitative and quantitative information.

Claims for contrast echocardiography services must be supported by
documentation that conventional studies were inconclusive and there was a need
for the contrast enhancement.

The medical record should clearly document the reasons for performing multiple
tests, as well as prior data which has been reviewed. If specific prior test
results were requested and not received, necessitating repeat or additional
testing, then this should also be noted in the records.

In the case of disease processes that could preclude the performance of
exercise stress testing, the medical documentation should clearly describe why
the patient cannot perform exercise stress testing. The documentation must
include (but is not limited to) history and physical exam findings
demonstrating that the patient could not reasonably be expected to perform
exercise stress testing.

Documentation of the qualifications of personnel performing tests, as
described in the Indications section of the LCD, should be available on
request.

In those instances in which repeat tests were denied, the physician must
document a good faith effort was made to identify them and to request copies
of them from previous providers, in order for NGS to consider reimbursement
for such tests on appeal.

Documentation must be available to Medicare upon request.  


**Utilization Guidelines:**

Repeat echocardiographic studies should be guided by the clinical status of
the patient. The frequency of services is guided by the circumstances outlined
in the Indications and Limitations section of the attached LCD. Repeat studies
are appropriate to monitor changes in cardiac structure or function when there
are changes in the clinical status of the patient, or when disease progression
is otherwise suspected.

Services performed in the Emergency Room and other emergency services are
excluded from any frequency limitations on coverage for repeat testing. While
Emergency Room services would be identified on the claim by the place of
service code (23), emergency services provided at other sites would require
post-pay review of the documentation provided in the medical record.

In those instances in which repeat tests were denied and a physician has
documented a good faith effort to identify them and to request copies of them
from previous providers, then NGS could reimburse such tests on appeal.