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The CPT® Code 93356 refers to a specialized procedure known as myocardial strain imaging, which utilizes a technique called speckle tracking to assess the mechanics of the heart muscle, specifically the myocardium. This non-invasive imaging method is performed in conjunction with echocardiography, a widely used diagnostic tool that employs ultrasound waves to create images of the heart. The primary focus of this procedure is to evaluate the function of the left ventricle (LV), which is crucial for effective blood circulation throughout the body. Myocardial strain imaging measures the deformation of the LV during different phases of the cardiac cycle, namely systole (when the heart contracts) and diastole (when the heart relaxes). The technique quantifies various types of myocardial deformation, including longitudinal, radial, and circumferential strain, providing valuable insights into myocardial dysfunction. This assessment is particularly beneficial in several clinical scenarios, such as evaluating myocardial viability, detecting acute allograft rejection in transplant patients, and identifying early signs of allograft vasculopathy. Additionally, strain imaging can aid in recognizing sub-clinical cardiac issues in patients with conditions like diabetes, systemic sclerosis, myocardial ischemia, arterial hypertension, and valvular heart diseases, as well as in predicting outcomes for patients experiencing acute heart failure. During the procedure, ultrasound images are captured using ECG gating in multiple views, including apical 4-chamber, 3-chamber, and 2-chamber views, as well as short-axis views at various levels of the heart. It is essential for the patient to hold their breath during image acquisition to ensure clarity and accuracy. After obtaining the images, specialized software analyzes the cardiac motion by tracking natural acoustic markers, known as speckles, present in the 2D ultrasound images. This tracking occurs frame by frame, allowing for the calculation of velocity and strain rates, which are critical for assessing myocardial function. It is important to note that CPT® Code 93356 should be reported separately as an adjunct to a primary echocardiography imaging procedure, highlighting its role in enhancing the overall assessment of cardiac health.
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The procedure of myocardial strain imaging using speckle tracking is indicated for various clinical scenarios where detailed assessment of myocardial function is necessary. The following conditions and situations warrant the use of this imaging technique:
The procedure for myocardial strain imaging using speckle tracking involves several key steps to ensure accurate assessment of myocardial mechanics. The following outlines the procedural steps:
Post-procedure care for patients undergoing myocardial strain imaging is generally minimal due to the non-invasive nature of the test. Patients may resume normal activities immediately following the procedure. However, it is essential for healthcare providers to review the results of the strain imaging with the patient, discussing any findings that may require further evaluation or intervention. Additionally, the results should be documented thoroughly in the patient's medical record, and appropriate follow-up appointments should be scheduled based on the findings of the strain imaging and the patient's overall clinical picture.
| Short Descr | MYOCRD STRAIN IMG SPCKL TRCK | Medium Descr | MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH | Long Descr | Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 93303 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article Transthoracic echocardiography for congenital cardiac anomalies; complete | 93304 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study | 93306 | MPFS Status: Active Code APC S CPT Assistant Article Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography | 93307 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography | 93308 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study | 93350 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article 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; | 93351 | MPFS Status: Active Code APC S CPT Assistant Article 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 | C8921 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete | C8922 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study | C8923 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography | C8924 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study | C8928 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography with contrast, or without contrast followed by with contrast, 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 | C8929 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography | C8930 | Medicare Coverage: Special Coverage Instructions APC S Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, 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 physician supervision |
| 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | CR | Catastrophe/disaster related | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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). | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GZ | Item or service expected to be denied as not reasonable and necessary | 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). | GW | Service not related to the hospice patient's terminal condition | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | 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. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | ET | Emergency services | FS | Split (or shared) evaluation and management visit | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | JZ | Zero drug amount discarded/not administered to any patient | LT | Left side (used to identify procedures performed on the left side of the body) | ME | The order for this service adheres to appropriate use criteria in the 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 | Q3 | Live kidney donor surgery and related services | 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 | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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