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The CPT® Code 93351 refers to a specific echocardiography procedure known as transthoracic echocardiography, which is performed in real-time and includes image documentation in two dimensions (2D). This procedure is comprehensive, as it encompasses M-mode recording when necessary, and is conducted during both rest and cardiovascular stress tests. The stress tests can be induced through various methods, including treadmill or bicycle exercise, or pharmacologically. The procedure is carried out under the supervision of a physician or another qualified healthcare professional, ensuring that the patient receives appropriate monitoring and care throughout the process.
During the procedure, if an electrocardiogram (ECG) is required for gating purposes, a three-lead ECG is connected to the patient. Initially, a baseline echocardiogram is obtained while the patient is at rest, allowing for a thorough evaluation of cardiac structure and dynamics. This evaluation is achieved through a series of real-time tomographic images, which are recorded either digitally or on videotape. The use of time-motion (M-mode) recordings is also incorporated as needed, facilitating dimensional measurements of the heart.
The assessment includes a detailed examination of various cardiac components, such as ventricular function, chamber sizes, wall thickness and motion, aortic roots, and cardiac valves. To capture comprehensive images, multiple transducer positions or orientations may be utilized, ensuring that images are obtained from various cardiac windows. Following the resting phase, the physician or qualified healthcare professional reviews the resting ECG and may order additional images to further investigate any identified abnormalities.
Once the exercise portion of the study begins, the patient's heart rate and blood pressure are continuously monitored. A continuous ECG may also be recorded during this phase. The procedure follows a staged stress protocol, with the patient's response to the stress being closely observed. Unless contraindicated, the exercise or pharmacological stress continues until the patient reaches their target heart rate or is unable to continue. Immediately after the stress component, images of the left ventricular wall motion are captured, which are then organized and submitted for review and interpretation.
Any abnormalities in cardiac structure or dynamics are noted, evaluated, and quantified. The physician compares the current study with any previous cardiac studies to identify changes. Finally, the physician or qualified healthcare professional provides an interpretation of the ECG along with a written report detailing the findings from the echocardiography procedure.
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The procedure described by CPT® Code 93351 is indicated for the evaluation of various cardiac conditions and is performed under specific circumstances. The following are the explicitly provided indications for this echocardiography procedure:
The procedure for CPT® Code 93351 involves several detailed steps that ensure a comprehensive evaluation of the heart during both rest and stress conditions. The following procedural steps are outlined:
After the completion of the echocardiography procedure, several post-procedure considerations are important for patient care. The patient is monitored until their heart rate returns to normal following the stress component. Once stable, the intravenous catheter used for administering any pharmacological agents or contrast agents is removed. The physician or qualified healthcare professional then reviews and interprets the contrast-enhanced images, if applicable, and provides a written report of the findings. This report includes a detailed analysis of any abnormalities noted during the procedure and any changes compared to previous studies, ensuring that the patient receives comprehensive follow-up care based on the results of the echocardiography.
| Short Descr | STRESS TTE COMPLETE | Medium Descr | ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG | Long Descr | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | I3C - Echography/ultrasonography - heart | MUE | 1 | CCS Clinical Classification | 193 - Diagnostic ultrasound of heart (echocardiogram) |
This is a primary code that can be used with these additional add-on codes.
| 0439T | Add On Code MPFS Status: Carrier Priced APC N ASC N1 Myocardial contrast perfusion echocardiography, at rest or with stress, for assessment of myocardial ischemia or viability (List separately in addition to code for primary procedure) | 93320 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete | 93321 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article 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 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) | 93352 | Addon Code MPFS Status: Active Code APC M CPT Assistant Article Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure) | 93356 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging) |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AO | Alternate payment method declined by provider of service | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | ET | Emergency services | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | KX | Requirements specified in the medical policy have been met | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | MF | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q3 | Live kidney donor surgery and related services | SU | Procedure performed in physician's office (to denote use of facility and equipment) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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