Article - Billing and Coding: Transthoracic Echocardiography (TTE) (A56781)

CMS National Coverage PolicyN/AArticle TextThis 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 ofthe 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.