Coding for Contrast

How is a stress echocardiogram with contrast reported in the physician office setting?
Report the stress echocardiogram (93350 or 93351) with contrast administration code 93352. In addition, report the applicable contrast agent codes (Q9955-Q9957).  Per the NCCI manual and correct coding edits, Medicare does not allow separate reporting for the IV insertion or injection procedure.

Can the physician report code 93352 contrast administration for stress echo for procedures performed in the hospital setting?
Yes, the physician may report CPT® 93352 for procedures performed in the hospital setting.

How are contrast echocardiography procedures reported by the hospital?
Medicare has established an entire family of HCPCS “C” echocardiography codes that allow the reporting of contrast administration.  These codes should be reported by the hospital when an outpatient contrast echo procedure is performed.  In addition to reporting the contrast procedure, the hospital should report the applicable contrast agent “Q” codes.  Per the NCCI manual and correct coding edits, Medicare does not allow separate reporting for the IV insertion or injection procedure.
Private payers may or may not use these HCPCS codes.  Check with payers.

Is there a contrast administration code for echocardiography exams (e.g. 93306) other than stress echoes?
No specific code is available to report contrast administration with other echocardiography procedures.

What administration code is reported for agitated saline studies?
There isn’t a specific echocardiography administration CPT® code for saline echo studies. Saline is reported with the applicable drug code (e.g., J7042) in addition to the usual echocardiography service code CPT (e.g. 93306, 93350, 93351, or 93312).  According to CPT Assistant (June 2005), Code 96374 (injection) may also be reported.  However, payers may not reimburse for it.

HCPCS codes for Stress Echocardiography with Contrast                                             

CMS created 8 new HCPCS Level II “C” codes that bundle the contrast agent and the echocardiography procedure.  Specifically, all types of echocardiography procedures (e.g. TTE, TEE, stress echo) may be reported to describe a contrast enhanced echocardiography procedure. Hospitals that perform echocardiograms without contrast should continue to use the existing Level I CPT codes (93303-93350) for these services.

Table 4 Medicare HCPCS “C” codes and abbreviated descriptors for contrast enhanced echocardiography procedures

HCPCS    Abbreviated Descriptors

C8921

TTE with contrast for congenital cardiac anomalies; complete

C8922

TTE with contrast for congenital cardiac anomalies; follow-up or limited study

C8923

TTE with contrast, (2D) with or without m-mode recording; complete

C8924

TTE with contrast, or without contrast followed by with contrast, (2D) with or without m-mode recording; follow-up or limited study

C8925

TEE with contrast, or without contrast followed by with contrast, (2D) (with or without m-mode recording); including probe placement, image acquisition, interp and report

C8926

TEE with or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interp and report

C8927

TEE with contrast or without contrast followed by with contrast, for monitoring purposes, including probe placement, 2-D image acquisition and interp leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis

C8928

TTE with contrast, or without contrast followed by with contrast, (2D), with or without m- mode recording, during rest and CV stress test using treadmill, bicycle exercise and/or  pharmacologically induced stress, with interp/report

C8929

 TTE with contrast, or without contrast followed by with contrast, (2D), includes m-mode  recording, when performed, complete, with spectral Doppler echocardiography, and  with color flow Doppler echocardiography

C8930

 TTE, with contrast, or without contrast followed by with contrast, (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill,  bicycle exercise and/or pharmacologically induced stress, with interp/report; including performance of continuous electrocardiographic monitoring, with physician supervision

Guidance

  • Hospitals are instructed by Medicare to bill for any type of echocardiography (e.g. TTE, TEE, SE) with contrast using the applicable HCPCS code(s) above. Private payers may also use these codes.
  • Report the supply of the contrast agent; selecting the applicable HCPCS contrast codes Q9955-Q9957 which are assigned by the specific type of contrast used. All other echocardiography contrast agents not described by Q9955-Q9957 shall be reported with A9700 (echo contrast agent).

Q9955 injection, perflexane lipid microspheres, per ml

Q9956 injection, octafluoropropane microspheres, per ml

Q9957 injection, perflutren lipid microspheres, per ml

  • Do not report the IV insertion (36000) or injection procedure (96374) to report the injection of contrast during echocardiography.
  • Report applicable Doppler echocardiography procedures (93320-93325), if clinically indicated.

Common coding scenarios for contrast echocardiography for hospital outpatient testing for Medicare patients

Contrast-enhanced stress echocardiogram C8930 + contrast Q code
Contrast-enhanced TTE with Doppler and color Doppler C8929 + contrast Q code
Contrast-enhanced TEE with Doppler and color Doppler C8925 + 93320 + 93325 + contrast Q code