FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
LCD Number
93303
Contractor
Name
First Coast Service
Options, Inc.
Contractor
Number
00590
LCD Title
Transthoracic
Echocardiography (TTE)
Coding
Guidelines
The utilization of contrast
(A9700 Supply of injectable contrast material for use in echocardiography, per
study) 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.
Studies with or
without contrast will be considered a single study, whether performed on the
same or sequential days.
Contrast
echocardiography is not covered when used to evaluate perfusion.
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.
Other
Comments
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, as defined by the American College of Cardiology/American
Heart Association Clinical Competence Statement on Echocardiography (2003), 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:
a.
The
service is performed by a physician; or
b.
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
c.
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:
a.
The
physician is board certified in Cardiovascular Diseases; or
b.
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
c.
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
d.
The
physician has staff privileges to interpret echocardiograms at a hospital that participates
in the Medicare program.
All
echocardiography services require a referring or an ordering physician.
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.
Revision
History
|
Date |
Revision |
|
01/01/2005 |
Original |
Document formatted:
11/04/2004 (CH/st)