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Centers for Medicare & Medicaid Services

LOCAL COVERAGE DETERMINATION


LCD for TRANSTHORACIC ECHOCARDIOGRAPHY (TTE) (L3123)

Contractor Information
 
Contractor Name 
National Government Services, Inc.  
Contractor Number 
00803 
Contractor Type 
Carrier 


LCD Information
 
LCD ID Number 
L3123 
 
LCD Title 
TRANSTHORACIC ECHOCARDIOGRAPHY (TTE) 
 
Contractor's Determination Number 
 
 
AMA CPT / ADA CDT Copyright Statement 
CPT codes, descriptions and other data only are copyright 2007 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.  
 
CMS National Coverage Policy 
  • Title XVIII of the Social Security Act, Section 1862 (a)(7)
    This section excludes routine physical examinations.
  • Title XVIII of the Social Security Act, Section 1862 (a)(1)(A)
    This section allows coverage and payment for only those services considered medically reasonable and necessary.
  • Title XVIII of the Social Security Act, Section 1833 (e)
    This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
  • CMS Manual System, Pub 100-4, Physician/Practitioner Billing, Chapter 12, Section 30-4.
    This section allows billing for contrast material for use in echocardiography
  • Program Memorandum, Transmittal AB-02-085 (CR 2194)
  • Program Memorandum, Transmittal AB-03-091 (CR 2763)
    Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
  • Program Memorandum, Transmittal B-03-040 (CR 2730).
    Update of the Place of Service (POS) Code Set

 
 
Primary Geographic Jurisdiction 
New York - Downstate
 
 
Oversight Region 
Region II
 
 
 
Original Determination Effective Date 
For services performed on or after 07/28/1995  
 
Original Determination Ending Date 
 
 
Revision Effective Date 
For services performed on or after 11/01/2007  
 
Revision Ending Date 
 
 
Indications and Limitations of Coverage and/or Medical Necessity 
Echocardiography is an ultrasonic examination of the heart. It is a widely used noninvasive technology to assess cardiac anatomy and function. A Doppler examination is a valuable adjunct to a complete echocardiographic examination. The basic principle utilizes the changes in frequency when a transmitted ultrasound wave is reflected from moving surfaces (e.g., heart valves, red blood cells), allowing the capability of measuring normal and abnormal velocities of blood flow. Such data may lead to the calculation of valvular stenosis, valvular regurgitation, cardiac output, intracardiac pressures or intracardiac shunts.

This policy addresses transthoracic echocardiography. Transesophageal echocardiography (TEE) is addressed in policy L3120 (for Empire Medicare Services, New York).

Indications:
Echocardiography is generally indicated in the evaluation of derangements of valvular, myocardial and pericardial function. The specific applications for coverage can be summarized by the following conditions:

  1. Native Valvular Heart Disease
    Detection of mitral stenosis was among the first practical clinical applications of TTE. TTE is well established as a technique of primary choice for the evaluation of valvular pathology and its effect upon global myocardial function. The relative severity of multi valve pathologies can be quantified. Visualization of the valve and valvular apparatus facilitates therapeutic decisions when competing therapeutic options exist; especially interventions for mitral stenosis.

  2. Prosthetic Heart Valves (Mechanical and Bio-prostheses)
    TTE assessment soon after prosthetic valve implant is important in establishing a baseline structural and hemodynamic profile unique to the individual and the prosthesis. Size, position, underlying ventricular function and concomitant valve pathologies all impact this unique profile. Reassessment following convalescence (3-6 months) is appropriate.

  3. Acute Endocarditis
    TTE can provide diagnostic information; larger vegetations may be directly visualized, valvular anatomy, and ventricular function directly assessed. The complications or sequelae of acute infective endocarditis can be detected and monitored over time. Acutely, examination frequency is dictated by the individual clinical course. When the acute process has been stabilized, the frequency of serial TTE evaluation will be dictated by the residual pathophysiology and discrete clinical events; analogous to the serial assessment of chronic valvular dysfunction and/or normally functioning prosthetic valves. (vide supra)

  4. Ventricular Function and Cardiomyopathies
    Changes in myocardial thickness (hypertrophy and thinning), chamber volume and morphology as well as derived parameters of contractility can be quantified and charted over time by TTE. Cardiac responses to volume perturbations, chronic pressure excess and therapeutic interventions can be monitored. Recognition of the relative contributions of myocardial and valvular functional perturbations to a clinical presentation is facilitated. TTE aids the recognition of myopathies and their classification into hypertrophic, dilated and restrictive types. There is increasing data to support the prognostic value of diastolic function parameters in patients with systolic dysfunction.

  5. Acute Myocardial Infarction and Coronary Insufficiency
    TTE can detect ischemic and infarcted myocardium. Regional motion, systolic thickening perturbations and mural thinning can be quantified and global functional adaptation assessed. The relative contributions of right ventricular ischemia and/or infarction can be evaluated. Complications of acute infarction (mural thrombi, papillary muscle dysfunction and rupture, septal defects, true or false aneurysm and myocardial rupture) can be diagnosed and their contribution to the overall clinical status placed in perspective. Following an initial TTE in the setting of acute infarction, repetition frequency will typically be dictated by the acute clinical course.

    The role for TTE in the emergency room assessment of individuals who present with chest pain is in evolution. This application may be used as part of a thoughtful clinical evaluation, especially as a triage decision on chest pain syndrome.

  6. Hypertensive Cardiovascular Disease
    Left ventricular hypertrophy (LVH) correlates with prognosis in hypertensive cardiovascular disease. Certain antihypertensive medications have been reported to stabilize and possibly contribute to the regression of left ventricular hypertrophy and the insidiously progressive development of left ventricular dysfunction and dilatation. In young individuals and in individuals with borderline hypertension, the decision to commit to long-term antihypertensive therapy may be determined by the presence of left ventricular hypertrophy and /or left ventricular mass calculation.

  7. Cardiac Transplant and Rejection Monitoring
    TTE is an integral part of the cardiac donor selection and donor recipient matching process. Evaluations focus on analysis of ventricular function and the integrity of valvular performance. TTE is also incorporated into the management of allograft recipients. Myocardial thickness, refractile properties, contractile patterns and indices, restrictive hemodynamics and the late development of pericardial fluid may alert to a rejection episode. None of these findings has achieved diagnostic sensitivity or specificity.

  8. Exposure to Cardiotoxic Agents (Chemotherapeutic and External)
    Measures of myocardial contractility, thinning and dilatation are important in the titration of therapeutic agents with known myocardial toxicity. When echocardiography is used to monitor cardiac toxicity of chemotherapeutic agents, an initial complete TTE may be performed prior to first administration of the agent with the frequency of repeat studies determined by the patient’s clinical course and the toxicity profile of the agent being administered.

  9. Pericardial Disease
    Detection and quantitation of the amount of pericardial effusion were among the first and remain an important application of TTE. Pericardial fluid accumulations of as little as twenty (20) milliliters have been reliably diagnosed by TTE. Cardiac motion and blood flow patterns demonstrated by TTE characterize the hemodynamic consequences of pericardial fluid accumulation. A collage of TTE findings have been found to be reliable indices of cardiac tamponade. TTE can be a valuable adjunct during the removal of pericardial fluid and creation of pericardial windows. The acute clinical status will dictate examination frequency. TTE and Doppler techniques are quite helpful in identifying pericardial constriction and differentiating it from restrictive myocardial disease.

  10. Congenital Heart Disease
    In children and young adults, TTE provides accurate anatomic definition of most congenital heart diseases. Coupled with Doppler hemodynamic measurements, TTE usually provides accurate diagnosis and noninvasive serial assessment. A technically adequate TTE can obviate the need for preoperative catheterization in select individuals.

  11. Cardiac Tumors and Masses
    Infiltrative and ventricular tumors and masses can be visualized, their extent quantified and their hemodynamic consequences assessed by TTE. Right atrial space occupying masses are usually well visualized by TTE. TEE provides a more detailed view of the left atrium and is more sensitive in quantifying mass characteristics (solid, cystic, etc.) extensions and attachments. These acute pathologies are not typically followed serially.

  12. Critically Ill and Trauma Patients
    There is a role for echocardiography in the management of critically ill patients and trauma victims. The cause of a persistent fever may be elucidated. The diagnosis of suspected aortic or central pulmonary pathology, cardiac contusion, or a pericardial effusion may be confirmed. Perturbations of volume status may be more completely defined and management strategies modified. The frequency of these typically acute studies will be dictated by the exigencies of the clinical milieu.

  13. Suspected Cardiac Thrombi and Embolic Sources
    TTE is particularly sensitive in the detection of ventricular thrombi and potentially embolic material. Limited visualization of atrial appendages and the more peripheral and superior portions of the atria render TTE less sensitive than TEE in the detection of atrial thrombus and potentially embolic material. In individuals with cardiac pathology associated with a high incidence of thromboemboli (valvular heart disease, arrhythmias such as atrial fibrillation, cardiomyopathies and ventricular dysfunction) TTE usually provides adequate supplemental therapeutic decisional data. In those instances where the precise diagnosis and localization of potentially embolic material is of paramount therapeutic importance (e.g. younger stroke patients, generally 45 years old or younger) and the information so obtained will potentially and substantively alter therapy, or the risk of anticoagulants is inordinately high, consideration should be given to TEE if TTE provides inadequate decisional information.

  14. Contrast echocardiography is indicated when a conventional study has failed to provide adequate and critically needed information on left ventricular function. A contrast agent is considered medically necessary when it is used to improve the delineation of the left ventricular endocardial borders in a patient whose non-contrast study is inadequate or suboptimal, and for whom the LV function information is essential to the management of the patient.

Limitations
  1. Echocardiographic studies that are not reasonable and necessary to obtain clinically significant diagnostic or monitoring information are not indicated. The carrier will utilize the American College of Cardiology/American Heart Association (ACC/AHA) Practice Guidelines (Class III) indications as a reference for such determinations.
  2. The utilization of contrast should not be routine protocol for any laboratory or office. The patients requiring contrast should be carefully selected and the decision to use contrast should be made following a pre-contrast study and an assessment of echocardiographic data that is required.
  3. Studies with or without contrast will be considered a single study, whether performed on the same or sequential days.
  4. Contrast echocardiography is not covered when used to evaluate perfusion.
  5. Training Requirements:
    While it is not the Carrier’s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services.
    The acceptable levels of competence are outlined as follows:

    For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions:
    1. The service is performed by a physician; or
    2. The service is performed by a technician who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or
    3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).

    For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements:
    1. The physician is board certified in Cardiovascular Diseases; or
    2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document; or
    3. The physician provides the interpretation in conjunction with a study that is performed at a laboratory that is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories and that is subject to such laboratory’s quality assurance policies and procedures; or
    4. The physician has staff privileges to interpret echocardiograms at a hospital that participates in the Medicare program.

    The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. However, a grace period of two years will be allowed for providers to acquire the necessary training.
  6. All echocardiography services require a referring or an ordering physician.
  7. Purchased service:
    A physician or group may bill the Medicare program and receive Part B payment, on assignment, for the technical portion of an echocardiography study. The purchasing physician or group may be the same physician or group ordering the test. The supplier performing the technical component must be enrolled in the Medicare program. The purchasing physician or group may not markup the charge from the purchase price, and must accept as full payment for the technical portion, the lowest amount when the Medicare fee schedule, the billing physician’s actual charge and the supplier’s net charge are compared.
  8. Limited Capability Ultrasound Scanners
    Some cardiac ultrasound machines have become increasingly compact and portable. Certain “hand carried” scanners are “full featured” and permit a skilled examiner to image and record permanent records of all of the tomographic images and Doppler data (Both color and spectral) needed to perform a complete transthoracic echocardiographic examination that may be quite comparable, in diagnostic value, to that obtained with a larger, “state of the art” instrument. In order to qualify as a valid echocardiographic service, the study must be done for an accepted clinical indication by a properly trained examiner and must include a permanent record of the findings, data sufficient to support the conclusions and an appropriate interpretation and written report. Such a study would meet the standards required for a complete echocardiographic examination, regardless of the size of the instrument used to perform the study.

    Some small scanners have more limited capabilities and lack either the permanent recording capabilities or some of the functional capabilities needed to perform a complete examination. Such a study may be quite useful as an extension of the physical examination. However, an examination that does not meet the standards required for a complete diagnostic echocardiographic examination – whether performed with a “conventional” scanner or a limited capability ultrasound scanner – will not be recognized as a valid echocardiographic service and will be non-covered.

     
 
Coverage Topic 
Diagnostic Tests and X-Rays
 


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

99999 Not Applicable
 
 
CPT/HCPCS Codes 
HCPCS codes Q9955-Q9957 are effective for dates of service on or after April 1, 2005.
36000 INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN
93303 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE
93304 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY
93307 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; COMPLETE
93308 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR LIMITED STUDY
93320 DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); COMPLETE
93321 DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); FOLLOW-UP OR LIMITED STUDY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING)
93325 DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHY)
A9700 SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
Q9955 INJECTION, PERFLEXANE LIPID MICROSPHERES, PER ML
Q9956 INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML
Q9957 INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML
 
 
ICD-9 Codes that Support Medical Necessity 
TRUNCATED DIAGNOSIS CODES ARE NOT ACCEPTABLE.

ICD-9-CM code listings may cover a range and include truncated codes. It is the provider’s responsibility to avoid truncated codes by selecting a code(s) carried out to the highest level of specificity and selected from the ICD-9-CM book appropriate to the year in which the service was performed.

It is not enough to link the procedure code to a correct, payable ICD-9-CM code. The diagnosis or clinical signs/symptoms must be present for the procedure to be paid.
Further, these ICD-9-CM codes can be used only with the conditions listed in the Indications and Limitations sections of this LCD.

038.0 STREPTOCOCCAL SEPTICEMIA
038.10 STAPHYLOCOCCAL SEPTICEMIA UNSPECIFIED
038.11 STAPHYLOCOCCUS AUREUS SEPTICEMIA
038.19 OTHER STAPHYLOCOCCAL SEPTICEMIA
038.2 PNEUMOCOCCAL SEPTICEMIA
038.3 SEPTICEMIA DUE TO ANAEROBES
038.40 - 038.44 SEPTICEMIA DUE TO GRAM-NEGATIVE ORGANISM UNSPECIFIED - SEPTICEMIA DUE TO SERRATIA
038.49 OTHER SEPTICEMIA DUE TO GRAM-NEGATIVE ORGANISMS
038.8 OTHER SPECIFIED SEPTICEMIAS
038.9 UNSPECIFIED SEPTICEMIA
074.21 COXSACKIE PERICARDITIS
074.22 COXSACKIE ENDOCARDITIS
074.23 COXSACKIE MYOCARDITIS
086.0 CHAGAS' DISEASE WITH HEART INVOLVEMENT
088.81 LYME DISEASE
093.0 ANEURYSM OF AORTA SPECIFIED AS SYPHILITIC
093.1 SYPHILITIC AORTITIS
093.20 - 093.24 SYPHILITIC ENDOCARDITIS OF VALVE UNSPECIFIED - SYPHILITIC ENDOCARDITIS OF PULMONARY VALVE
093.81 SYPHILITIC PERICARDITIS
093.82 SYPHILITIC MYOCARDITIS
098.84 GONOCOCCAL ENDOCARDITIS
112.81 CANDIDAL ENDOCARDITIS
115.03 HISTOPLASMA CAPSULATUM PERICARDITIS
115.04 HISTOPLASMA CAPSULATUM ENDOCARDITIS
115.13 HISTOPLASMA DUBOISII PERICARDITIS
115.14 HISTOPLASMA DUBOISII ENDOCARDITIS
130.3 MYOCARDITIS DUE TO TOXOPLASMOSIS
135 SARCOIDOSIS
164.1 MALIGNANT NEOPLASM OF HEART
212.7 BENIGN NEOPLASM OF HEART
275.0 DISORDERS OF IRON METABOLISM
276.50 VOLUME DEPLETION, UNSPECIFIED
276.51 DEHYDRATION
276.52 HYPOVOLEMIA
277.30 AMYLOIDOSIS, UNSPECIFIED
277.39 OTHER AMYLOIDOSIS
324.0 INTRACRANIAL ABSCESS
324.1 INTRASPINAL ABSCESS
327.20 ORGANIC SLEEP APNEA, UNSPECIFIED
327.21 PRIMARY CENTRAL SLEEP APNEA
327.23 OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC)
362.34 TRANSIENT RETINAL ARTERIAL OCCLUSION
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
392.0 RHEUMATIC CHOREA WITH HEART INVOLVEMENT
393 CHRONIC RHEUMATIC PERICARDITIS
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
398.0 RHEUMATIC MYOCARDITIS
398.91 RHEUMATIC HEART FAILURE (CONGESTIVE)
398.99 OTHER RHEUMATIC HEART DISEASES
401.0 MALIGNANT ESSENTIAL HYPERTENSION
402.00 - 402.01 MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE - MALIGNANT HYPERTENSIVE HEART DISEASE WITH HEART FAILURE
402.10 - 402.11 BENIGN HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE - BENIGN HYPERTENSIVE HEART DISEASE WITH HEART FAILURE
402.90 - 402.91 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE - UNSPECIFIED HYPERTENSIVE HEART DISEASE WITH HEART FAILURE
404.00 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.01 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.02 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.03 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.10 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.11 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.12 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.13 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.90 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.91 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.92 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.93 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
405.01 MALIGNANT RENOVASCULAR HYPERTENSION
410.00 - 410.91 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE INITIAL 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
412 OLD MYOCARDIAL INFARCTION
413.0 ANGINA DECUBITUS
413.1 PRINZMETAL ANGINA
413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS
414.00 - 414.07 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT - 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
414.2* CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY
414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE
414.9 CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED
415.0 ACUTE COR PULMONALE
415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION
415.19 OTHER PULMONARY EMBOLISM AND INFARCTION
416.0 PRIMARY PULMONARY HYPERTENSION
416.1 KYPHOSCOLIOTIC HEART DISEASE
416.8 OTHER CHRONIC PULMONARY HEART DISEASES
420.0 ACUTE PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE
420.90 ACUTE PERICARDITIS UNSPECIFIED
420.91 ACUTE IDIOPATHIC PERICARDITIS
420.99 OTHER ACUTE PERICARDITIS
421.0 ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS
421.1 ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
421.9 ACUTE ENDOCARDITIS UNSPECIFIED
422.0 ACUTE MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
422.90 - 422.93 ACUTE MYOCARDITIS UNSPECIFIED - TOXIC MYOCARDITIS
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
425.1 HYPERTROPHIC OBSTRUCTIVE 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
426.0 ATRIOVENTRICULAR BLOCK COMPLETE
426.12 MOBITZ (TYPE) II ATRIOVENTRICULAR BLOCK
426.3 OTHER LEFT BUNDLE BRANCH BLOCK
426.7 ANOMALOUS ATRIOVENTRICULAR EXCITATION
426.9 CONDUCTION DISORDER UNSPECIFIED
427.0 PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
427.1 PAROXYSMAL VENTRICULAR TACHYCARDIA
427.2 PAROXYSMAL TACHYCARDIA UNSPECIFIED
427.31 - 427.32 ATRIAL FIBRILLATION - ATRIAL FLUTTER
427.41 - 427.42 VENTRICULAR FIBRILLATION - VENTRICULAR FLUTTER
427.5 CARDIAC ARREST
427.60 - 427.61 PREMATURE BEATS UNSPECIFIED - SUPRAVENTRICULAR PREMATURE BEATS
427.69 OTHER PREMATURE BEATS
427.81 SINOATRIAL NODE DYSFUNCTION
427.89 OTHER SPECIFIED CARDIAC DYSRHYTHMIAS
427.9 CARDIAC DYSRHYTHMIA UNSPECIFIED
428.0 CONGESTIVE HEART FAILURE UNSPECIFIED
428.1 LEFT HEART FAILURE
428.20 - 428.23 UNSPECIFIED SYSTOLIC HEART FAILURE - ACUTE ON CHRONIC SYSTOLIC HEART FAILURE
428.30 - 428.33 UNSPECIFIED DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC DIASTOLIC HEART FAILURE
428.40 - 428.43 UNSPECIFIED COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE
428.9 HEART FAILURE UNSPECIFIED
429.0 MYOCARDITIS UNSPECIFIED
429.1 MYOCARDIAL DEGENERATION
429.3 CARDIOMEGALY
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
429.79 CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED OTHER
429.81 OTHER DISORDERS OF PAPILLARY MUSCLE
429.82 HYPERKINETIC HEART DISEASE
429.83 TAKOTSUBO SYNDROME
429.89 OTHER ILL-DEFINED HEART DISEASES
429.9 HEART DISEASE UNSPECIFIED
434.00 - 434.91 CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITH CEREBRAL INFARCTION
435.0 BASILAR ARTERY SYNDROME
435.1 VERTEBRAL ARTERY SYNDROME
435.2 SUBCLAVIAN STEAL SYNDROME
435.3 VERTEBROBASILAR ARTERY SYNDROME
435.8 OTHER SPECIFIED TRANSIENT CEREBRAL ISCHEMIAS
435.9 UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA
436 ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE
440.0 ATHEROSCLEROSIS OF AORTA
441.00 - 441.03 DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE - DISSECTION OF AORTA THORACOABDOMINAL
441.1 THORACIC ANEURYSM RUPTURED
441.2 THORACIC ANEURYSM WITHOUT RUPTURE
441.3 ABDOMINAL ANEURYSM RUPTURED
441.4 ABDOMINAL ANEURYSM WITHOUT RUPTURE
441.5 AORTIC ANEURYSM OF UNSPECIFIED SITE RUPTURED
441.6 THORACOABDOMINAL ANEURYSM RUPTURED
441.7 THORACOABDOMINAL ANEURYSM WITHOUT RUPTURE
441.9 AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE
442.0 ANEURYSM OF ARTERY OF UPPER EXTREMITY
442.1 ANEURYSM OF RENAL ARTERY
442.2 ANEURYSM OF ILIAC ARTERY
442.3 ANEURYSM OF ARTERY OF LOWER EXTREMITY
442.81 - 442.84 ANEURYSM OF ARTERY OF NECK - ANEURYSM OF OTHER VISCERAL ARTERY
442.89 ANEURYSM OF OTHER SPECIFIED SITE
442.9 OTHER ANEURYSM OF UNSPECIFIED SITE
443.0 RAYNAUD'S SYNDROME
443.1 THROMBOANGIITIS OBLITERANS (BUERGER'S DISEASE)
443.21 DISSECTION OF CAROTID ARTERY
443.22 DISSECTION OF ILIAC ARTERY
443.23 DISSECTION OF RENAL ARTERY
443.24 DISSECTION OF VERTEBRAL ARTERY
443.29 DISSECTION OF OTHER ARTERY
443.81 PERIPHERAL ANGIOPATHY IN DISEASES CLASSIFIED ELSEWHERE
443.89 OTHER PERIPHERAL VASCULAR DISEASE
443.9 PERIPHERAL VASCULAR DISEASE UNSPECIFIED
444.0 EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA
444.1 EMBOLISM AND THROMBOSIS OF THORACIC AORTA
444.21 - 444.22 ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY - 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
445.01 - 445.02 ATHEROEMBOLISM OF UPPER EXTREMITY - ATHEROEMBOLISM OF LOWER EXTREMITY
445.81 ATHEROEMBOLISM OF KIDNEY
445.89 ATHEROEMBOLISM OF OTHER SITE
446.1 ACUTE FEBRILE MUCOCUTANEOUS LYMPH NODE SYNDROME (MCLS)
446.7 TAKAYASU'S DISEASE
449* SEPTIC ARTERIAL EMBOLISM
458.0 ORTHOSTATIC HYPOTENSION
458.29 OTHER IATROGENIC HYPOTENSION
458.8 OTHER SPECIFIED HYPOTENSION
458.9 HYPOTENSION UNSPECIFIED
518.4 ACUTE EDEMA OF LUNG UNSPECIFIED
518.82 OTHER PULMONARY INSUFFICIENCY NOT ELSEWHERE CLASSIFIED
674.82 OTHER COMPLICATIONS OF PUERPERIUM WITH DELIVERY WITH POSTPARTUM COMPLICATION
674.84 OTHER COMPLICATIONS OF PUERPERIUM
710.0 SYSTEMIC LUPUS ERYTHEMATOSUS
745.0 COMMON TRUNCUS
745.10 - 745.12 COMPLETE TRANSPOSITION OF GREAT VESSELS - 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 - 745.61 ENDOCARDIAL CUSHION DEFECT UNSPECIFIED TYPE - 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 - 746.02 CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED - 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 - 746.87 SUBAORTIC STENOSIS CONGENITAL - 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 - 747.11 COARCTATION OF AORTA (PREDUCTAL) (POSTDUCTAL) - INTERRUPTION OF AORTIC ARCH
747.20 - 747.22 CONGENITAL ANOMALY OF AORTA UNSPECIFIED - CONGENITAL ATRESIA AND STENOSIS OF AORTA
747.29 OTHER CONGENITAL ANOMALIES OF AORTA
747.3 CONGENITAL ANOMALIES OF PULMONARY ARTERY
747.40 - 747.42 CONGENITAL ANOMALY OF GREAT VEINS UNSPECIFIED - PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION
747.49 OTHER ANOMALIES OF GREAT VEINS
759.3 SITUS INVERSUS
759.82 MARFAN SYNDROME
770.81 PRIMARY APNEA OF NEWBORN
770.82 OTHER APNEA OF NEWBORN
770.89 OTHER RESPIRATORY PROBLEMS AFTER BIRTH
771.83 BACTEREMIA OF NEWBORN
779.81 NEONATAL BRADYCARDIA
779.82 NEONATAL TACHYCARDIA
779.89 OTHER SPECIFIED CONDITIONS ORIGINATING IN THE PERINATAL PERIOD
780.01 COMA
780.02 TRANSIENT ALTERATION OF AWARENESS
780.2 SYNCOPE AND COLLAPSE
780.51 INSOMNIA WITH SLEEP APNEA, UNSPECIFIED
780.53 HYPERSOMNIA WITH SLEEP APNEA, UNSPECIFIED
780.6 FEVER
782.3 EDEMA
782.5 CYANOSIS
784.3 APHASIA
785.1 PALPITATIONS
785.2 UNDIAGNOSED CARDIAC MURMURS
785.3 OTHER ABNORMAL HEART SOUNDS
785.50 SHOCK UNSPECIFIED
785.51 CARDIOGENIC SHOCK
785.52 SEPTIC SHOCK
785.59 OTHER SHOCK WITHOUT TRAUMA
786.03 APNEA
786.04 CHEYNE-STOKES RESPIRATION
786.05 SHORTNESS OF BREATH
786.06 TACHYPNEA
786.07 WHEEZING
786.09 RESPIRATORY ABNORMALITY OTHER
786.50 UNSPECIFIED CHEST PAIN
786.51 PRECORDIAL PAIN
786.59 OTHER CHEST PAIN
790.7 BACTEREMIA
794.31 NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM (ECG) (EKG)
807.4 FLAIL CHEST
861.01 - 861.13 CONTUSION OF HEART WITHOUT OPEN WOUND INTO THORAX - LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS AND OPEN WOUND INTO THORAX
901.0 INJURY TO THORACIC AORTA
901.2 INJURY TO SUPERIOR VENA CAVA
901.41 INJURY TO PULMONARY ARTERY
901.42 INJURY TO PULMONARY VEIN
958.0 AIR EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA
958.1 FAT EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA
958.4 TRAUMATIC SHOCK
963.1 POISONING BY ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE DRUGS
990 EFFECTS OF RADIATION UNSPECIFIED
995.20 UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE
995.22 UNSPECIFIED ADVERSE EFFECT OF ANESTHESIA
995.29 UNSPECIFIED ADVERSE EFFECT OF OTHER DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE
996.00 - 996.09 MECHANICAL COMPLICATIONS OF UNSPECIFIED CARDIAC DEVICE IMPLANT AND GRAFT - OTHER MECHANICAL COMPLICATION OF CARDIAC DEVICE IMPLANT AND GRAFT
996.1 MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.60 INFECTION AND INFLAMMATORY REACTION DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT
996.61 INFECTION AND INFLAMMATORY REACTION DUE TO CARDIAC DEVICE IMPLANT AND GRAFT
996.62 INFECTION AND INFLAMMATORY REACTION DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.63 INFECTION AND INFLAMMATORY REACTION DUE TO NERVOUS SYSTEM DEVICE IMPLANT AND GRAFT
996.66 INFECTION AND INFLAMMATORY REACTION DUE TO INTERNAL JOINT PROSTHESIS
996.71 OTHER COMPLICATIONS DUE TO HEART VALVE PROSTHESIS
996.72 OTHER COMPLICATIONS DUE TO OTHER CARDIAC DEVICE IMPLANT AND GRAFT
996.83 COMPLICATIONS OF TRANSPLANTED HEART
997.1 CARDIAC COMPLICATIONS NOT ELSEWHERE CLASSIFIED
998.0 POSTOPERATIVE SHOCK NOT ELSEWHERE CLASSIFIED
998.51 INFECTED POSTOPERATIVE SEROMA
998.59 OTHER POSTOPERATIVE INFECTION
999.31* INFECTION DUET CENTRAL VENOUS CATHETER
999.39* INFECTION FOLLOWING OTHER INFUSION, INJECTION, TRANSFUSION, OR VACCINATION
E933.1 ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE DRUGS CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE
V42.1 HEART REPLACED BY TRANSPLANT
V42.2 HEART VALVE REPLACED BY TRANSPLANT
V43.21 HEART REPLACED BY HEART ASSIST DEVICE
V43.22 HEART REPLACED BY FULLY IMPLANTABLE ARTIFICIAL HEART
V43.3 HEART VALVE REPLACED BY OTHER MEANS
V72.83 OTHER SPECIFIED PRE-OPERATIVE EXAMINATION
V81.2 SCREENING FOR OTHER AND UNSPECIFIED CARDIOVASCULAR CONDITIONS
* ICD-9-CM codes effective for dates of service on or after 10/01/2007.
 
 
Diagnoses that Support Medical Necessity 
N/A 
 
ICD-9 Codes that DO NOT Support Medical Necessity 
Use of any ICD-9-CM code not listed in the “ICD-9-CM Codes that Support Medical Necessity” section of this LCD will be denied.
 
 
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 
 
 
Diagnoses that DO NOT Support Medical Necessity 
N/A 


General Information
 
Documentation Requirements 
  1. Each claim must be submitted with ICD-9-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-9-CM codes will be returned.
  2. 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. The quality of images obtained on any given exam is dependent on the instrumentation, the operator and the patient.
  3. 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 chose valid substitutes for these parameters such as LV volumes, ejection fraction and mass measurements.
  4. A Doppler interrogation should state the modes used and should give both qualitative and quantitative information where appropriate.
  5. Claims for contrast echocardiography services must be supported by documentation that conventional studies were inconclusive and there was a need for the contrast enhancement.
  6. Documentation must be available to Medicare upon request.
     
 
Appendices 
N/A 
 
Utilization Guidelines 
Repeat echocardiographic studies should be guided by the clinical status of the patient. The frequency of services is governed by the circumstances outlined in the Indications and Limitations section of this policy. Repeat studies are appropriate to monitor changes in cardiac structure or function when there are clinical changes in the status of the patient, or when disease progression is otherwise suspected. 
 
Sources of Information and Basis for Decision 
  1. LMRP Workgroup, American College of Cardiology and American Society of Echocardiography
  2. American College of Cardiology, Guidelines for the Clinical Application of Echocardiography, www.acc.org.
  3. CPT Assistant, Volume 7, issue 12, December 1997: 5-6
  4. Quinones, Miguel A., MD, et al. “ACC/AHA Clinical Competence Statement on Echocardiography.” Journal of the American College of Cardiology. 41.4 (2003): 687-708.
  5. Otto, Catherine M., MD. The Practice of Clinical Echocardiography. 2nd ed. Philadelphia, PA: W.B. Saunders Company, 2002.
  6. Braunwald, Eugene, MD. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: W.B. Saunders Company, 2001.
  7. CMD Cardiology Work Group
     
 
Advisory Committee Meeting Notes 
Advisory Committee Meeting Date: 06/11/2003

This LCD does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this LCD was developed in cooperation with advisory groups, which includes representatives from the New York and New Jersey State Chapters of the American College of Cardiology. Special recognition goes to the LMRP work group of the American College of Cardiology, to the American Society of Echocardiography and to the Carrier Medical Directors Cardiology workgroup.
 
 
Start Date of Comment Period 
06/11/2003 
 
End Date of Comment Period 
07/25/2003 
 
Start Date of Notice Period 
11/01/2007 
 
Revision History Number 
9 
 
Revision History Explanation 
9
As part of the annual ICD-9-CM update, the following ICD-9-CM codes have been added: 414.2, 423.3, 449, 999.31 and 999.39. Although this revision was done on 11/01/2007 the changes described above are effective for dates of service on or after 10/01/2007.
Date Posted 11/01/2007.

Revision Number: 8
1. Added new ICD-9-CM codes 277.30, 277.39, 429.83, 995.20, 995.22 and 995.29, effective for dates of service on or after 10/01/2006.
2. The description of ICD-9-CM codes 404.00-404.03, 404.10-404.13 and 404.90-404.93 has been revised, effective for dates of service on or after 10/01/2006.
Date Posted: 10/27/2006

Revision Number: 7
As a result of the annual ICD-9-CM code update, effective for dates of service on or after 10/01/2005.:
New codes 276.50-276.52, 327.20, 327.21 and 327.23 were added.
The description for codes 404.00-404.93 has been revised.

CV011E04
Per CR 3748 HCPCS codes Q9955-Q9957 were added effective for dates of service on or after April 1, 2005.

CV011E03
  • Effective for dates of service on or after 04/19/2004
    1. This revision addresses clinical competence, hand-carried ultrasound devices, training requirements and purchased services.
    2. The following sections were revised as well:
    - CMS National Coverage Policy
    - Indications and Limitations of Coverage and/or
    Medical Necessity
    - Documentation Requirements
    - Utilization Guidelines
    - CPT /HCPCS Codes
  • Added ICD-9-CM codes 038.0 – 038.9 and 786.50 as payable diagnosis, effective date 5/30/2001
  • Per Transmittal AB-03-091 (CR 2763) the following ICD-9-CM codes were added: 414.07, 458.21, 458.29, 785.52, V43.21 and V43.22, effective for dates of service on or after 10/01/2003
  • Per Transmittal B-03-040 (CR 2730) POS 49 was added, effective 10/01/2003.

    CV011E02
  • The following ICD-9-CM codes are added: 996.60, 996.62, 996.63, 996.66 and 998.5 is expanded to include 998.51 and 998.59.
  • Corrections to Revision #2 regarding places of services in coding guidelines #9. Inserted Non-covered ICD-9-CM code V82.9 which was inadvertently omitted.
  • Effective