PHILIPS 2024 Structural Heart Disease Imaging User Manual

2024 Structural Heart Disease Imaging
User Manual Structural Heart
Disease Imaging
2024 Medicare coding and reimbursement
Medicare National Averages

2024 Structural Heart Disease Imaging

Legal disclaimer

All coding, coverage, billing and payment information provided herein by Philips is gathered from third-party sources and is subject to change. The information is intended to serve as a general reference guide and does not constitute reimbursement or legal advice. For all coding, coverage and reimbursement matters or questions about the information contained in this material, Philips recommends that you consult with your payers, certified coders, reimbursement specialists and/or legal counsel. Philips does not guarantee that the use of any particular codes will result in coverage or payment at any specific level. Coverage for these procedures may vary by Payer. Philips recommends that providers verify coverage prior to date of service. This information may include some codes for procedures for which Philips currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any products. The selection of a code must reflect the procedure(s) documented in the medical record. Providers are responsible for determining medical necessity, the proper place of service, and for submitting accurate claims. Payment amounts set forth herein are specific to Medicare Fee for Service providers based on Medicare national average 2024 payment rates only and do not take into account any hospital or physician payment increases or decreases based on performance measures. Private payer rates will vary. Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all- inclusive list. We recommend consulting coding, payment and CCI manuals for appropriate coding options. Philips does not promote the use of its products outside their FDA-approved label.
ICD-10 coding
ICD-10-CM diagnosis1
Due to the varying coding options available, specific ICD-10 diagnosis codes are not listed in this guide. Refer to
ICD-10-CM 2024: The Complete Official Codebook for complete coding options.
ICD-10 procedure 2
Refer to ICD-10-PCS 2024: The Complete Official Codebook for complete coding options and guidelines.
Questions
Contact Philips Reimbursement Resource Center
Phone: (858) 720.4030
Email: IGTDReimbursement@philips.com
CPT Copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
Medicare 2024 National Reimbursement Guide Structural Heart Disease Imaging (ICE & TEE)
Hospital Inpatient MS-DRGs (Medicare Severity Diagnosis Related Groups)
Medicare reimburses inpatient care under the FY2024 Inpatient Prospective Payment System (IPPS), which utilizes the Medicare Severity Diagnosis Related Groups (MS-DRGs) system. MS-DRG payment is driven by the patient ‘s  primary procedure (eg, ablation) and/or diagnosis(es) as documented in the patient’s medical record. Use of ICE, TTE and TEE does not affect MS-DRG assignment, as they are not the principal reason for admission. The DRGs listed  below are most common for structural heart procedures.

MSDRG| Descriptor| Medicare 2024 National
Average Payment
---|---|---
LAAC / PFO / Intracardiac Ablation
273
274| Percutaneous and other intracardiac procedures wo MCC
Percutaneous and other intracardiac procedures w/ MCC| $27,285
$22,691
Ventricular septal defect closure
228
229| Other cardiothoracic procedures with MCC
Other cardiothoracic procedures without MCC| $35,279
$22,262
Mitral valve / Tricuspid valve / TAVR / TEER
266
267| Endovascular cardiac valve replacement & supplement procedures with MCC
Endovascular cardiac valve replacement & supplement procedures without MCC| $34,169
$43,733

Hospital Outpatient and Physician – Medicare 2024 National Average Payment

Physician

| | Outpatient Hospital| | Facility| Non facility (OBL)
CPT
Code| CPT description| APC/ Status Payment| Work
RVU| Total RVU
Payment| Total RVU
Payment
Intracardiac Echocardiography (ICE)
93662| Intracardiac echocardiography during therapeutic/diagnostic intervention, including ing supervision and interpretation (List separately in addition to cod for primary procedure)| N Packaged| 1.44| 2.05 $68| Not payable
In instances where ICE is performed with a CPT code outside of the primary codes listed in this guide (such as tricuspid procedures
other than 0545T), the unlisted code 93799 should be used.
93799| Unlisted cardiovascular service or procedure| 5721/S $149| NA| Carrier Determined| Carrier Determined

Tips for Billing ICE
CPT code +93662 (I CE) is a designated add-on code, which per CPT® definition, may only be reported in conjunct ion with a primary procedure. This guide lists structural heart procedures considered primary procedure codes for +93662 (I CE). Consult your current CPT guide for a ll appropriate primary codes reportable with I CE. I n instances where I CE is the only procedure performed or is performed outside of the primary codes listed in this guide, the  unlisted code 93799 should be used.
Report CPT code +93662 once per patient encounter. This includes preliminary evaluation, use during an intervention and follow up studies.
Do not use Coronary IVUS, OCT or Doppler codes to describe ICE procedures. ICE procedures are utilized for evaluation of cardiac chamber, structure and morphology.
Hospital Outpatient and Physician – Medicare 2024 Coding and Payment

Structural Heart – Primary Procedures for ICE

Physician

| | Outpatient
Hospital| | Facility| Non facility (OBL)
CPT
Code| CPT description| APC/ Status Payment| Work
RVU| Total RVU
Payment| Total RVU
Payment
Intracardiac Echocardiography (ICE)
33340| Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation| Inpatient only| 14| 22.84 $760| Not payable
93580| Percutaneous transcatheter closure of congenital interatrial communication  (ie, Fontan fenestration, atrial septal defect) with implant| 5194/J1 $16,707| 17.97| 28.52 $949| Not payable
Septal defect / PFO
93580| Percutaneous transcatheter closure of congenital interatrial communication  (ie, Fontan fenestration, atrial septal defect) with implant| 5194/J1 $16,707| 17.97| 28.52 $949| Not payable
93581| Percutaneous transcatheter closure of a congenital ventricular septal defect with implant| 5194/J1 $16,707| 24.39| 38.70 $1,288| Not payable
93582| Percutaneous transcatheter closure of patent ductus arteriosus| 5194/J1 $16,707| 12.31| 19.32 $643| Not payable
93583| Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed| Inpatient only| 13.75| 21.68 $722| Not payable
Transcatheter atrial septostomy (TAS)
33741| Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to  create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rash kind, Sang Park, balloon, cutting balloon, blade)| Inpatient only| 14| 21.99 $732| Not payable
Transcatheter intracardiac shunt (TIS)
33745| Transcatheter intracardiac shunt (TIS) creation by stent placement for congenita l cardiac anima lies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract,  ustard/Senning/Warden baffles); initial intracardiac shunt| Inpatient only| 20| 31.42 $1,046| Not payable
Aortic valve
92986| Percutaneous balloon valvuloplasty; aortic valve| 5192/J1 $5,446| 22.6| 38.98 $1,298| Not payable
93591| Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve| 5194/J1 $16,707| 17.97| 25.70 $855| Not payable
Mitral valve
33418| Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis| Inpatient only| 32.25| 52.84 $1,759| Not payable
Mitral valve (continued)
92987| Percutaneous balloon valvuloplasty; mitral valve| 5193/J1 $10,482| 23.38| 40.17 $1,337| Not payable
93590| Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve| 5194/J1 $16,707| 21.7| 31.26 $1,041| Not payable
0345T| Transcatheter mitral valve repair percutaneous approach via the coronary sinus| Inpatient only| NA| Carrier Determined| Carrier Determined
0483T| Transcatheter mitral valve implantation/replacement
(TMVI) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed| Inpatient only| NA| Carrier Determined| Carrier Determined
0484T| Transcatheter mitral valve implantation/ replacement (TMVI) with prosthetic  valve; transthoracic exposure (eg, thoracotomy, transapical)| Inpatient only| NA| Carrier Determined| Carrier Determined
0543T| Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement
of artificial chordae tendineae| Inpatient only| NA| Carrier Determined| Carrier Determined
0544T| Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture| Inpatient only| NA| Carrier Determined| Carrier Determined
Tricuspid valve
0545T| Transcatheter tricuspid valve annulus reconstruction with implantation of  adjustable annulus reconstruction device, percutaneous approach| Inpatient only| NA| Carrier Determined| Carrier Determined
Pulmonary valve
33477| Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed| 5193/J1 $10,482| 25| 38.37 $1,277| Not payable
92990| Percutaneous balloon valvuloplasty; pulmonary valve| Inpatient only| 18.27| 32.17 $1,071| Not payable
Transcatheter aortic valve replacement (TAVR)
33361| Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve;  percutaneous femoral artery approach| Inpatient only| 22.47| 35.42 $1,179| Not payable
33362| ; open femoral artery approach| Inpatient only| 24.54| 38.60 $1,285| Not payable
33363| ; open axillary artery approach| Inpatient only| 25.47| 40.06 $1,334| Not payable
33364| ; open iliac artery approach| Inpatient only| 25.97| 39.88 $1,328| Not payable
33365|  ; transaortic approach (eg, median sternotomy, mediastinotomy)| Inpatient only| 26.59| 41.73 $1,389| Not payable
33366| ; transapical exposure (eg, left thoracotomy)| Inpatient only| 29.35| 45.92 $1,529| Not payable
Pulmonary artery – angioplasty
92997| Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel| 5193/J1 $10,482| 11.98| 18.53 $617| Not payable
EP Ablation
93620| Comprehensive electrophysiology ice valuation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording| 5212/J1 $7,116| 11.32| 17.97 $598| Not payable
93653| Comprehensive EP eval with insert ion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, inc intracardiac electrophysiologic 3-dimensional mapping, right
ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of supraventricular tachycardia by ablate ion of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo- tricuspid isthmus or other sing le atrial focus or source of atrial re-entry| 5213/J1 $22,629| 15| 24.42 $813| Not payable
93654| Comprehensive EP eval with insert ion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, inc. intracardiac electrophysiologic 3-dimensional mapping, right
ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed;  with treatment of ventricular tachycardia or focus of ventricular ectopy including left ventricular pacing and recording, when performed| 5213/J1 $22,629| 18.1| 29.42 $979| Not payable
93656| Comprehensive EP eval including transseptal catheterizations, insertion and  repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, inc. intracardiac electrophysiology i.c 3dimensional mapping, intracardiac echocardiography
including imaging supervision and interpretation,  induction or attempted
induction of an arrhythmia  including left or right atrial pacing/recording,
right  ventricular pacing/recording, and His bundle  recording, when performed| 5213/J1 $22,629| 17| 27.69 $922| Not payable
Cardiac Catheterization
93451| Right heart catheterization including measurement(s)of oxygen saturation and cardiac output, when performed| 5191/J1 $3,105| 2.47| 3.81 $127| 25.50 $849
93452| Left heart catheterization including intraprocedural injection(s) for left  ventriculography, imaging supervision and interpretation, when performed| 5191/J1 $3,105| 4.5| 6.89 $229| 26.52 $883
93453| Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed| 5191/J1 $3,105| 5.99| 9.20 $306| 33.84 $1,126
93454| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;| 5191/J1 $3,105| 4.54| 6.96 $232| 26.74 $890
93455|  ; with catheter placement(s) in bypass graft(s) (internal mammary, free  arterial, venous grafts) including intraprocedural injection(s) for bypass graft
angiography| 5191/J1 $3,105| 5.29| 8.11 $270| 29.79 $992
93456|  ; with right heart catheterization| 5191/J1 $3,105| 5.9| 9.07 $302| 33.27 $1,107
93457|  ; with catheter placement(s) in bypass graft(s) (internal mammary, free  arterial, venous grafts) including intraprocedural injection(s) for bypass  graft angiography and right heart catheterization| 5191/J1 $3,105| 6.64| 10.18 $339| 36.26 $1,207
93458|  ; with left heart catheterization including intraprocedural injection(s) for left  ventriculography, when performed| 5191/J1 $3,105| 5.6| 8.59 $286| 30.76 $1,024
93459|  ; with left heart catheterization including intraprocedural injection(s) for left  ventriculography, when performed, catheter placement(s) in bypass
graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography| 5191/J1 $3,105| 6.35| 9.73 $324| 33.09 $1,101
93460|  ; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed| 5191/J1 $3,105| 7.1| 10.88 $362| 36.71 $1,222
93461|  ; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography| 5191/J1 $3,105| 7.85| 12.03 $400| 40.50 $1,348
93593| Right heart catheterization for congenital heart defect(s) including imaging  guidance by the proceduralist to advance the catheter to the target zone;  normal native connections| 5191/J1 $3,105| 3.99| 5.51 $183| Not payable
93594| Right heart catheterization for congenital heart defect(s) including imaging  guidance by the proceduralist to advance the catheter to the target zone;  abnormal native connections| 5191/J1 $3,105| 6.1| 8.37 $279| Not payable
93595| Left heart catheterization for congenital heart defect(s) including imaging  guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections| 5191/J1 $3,105| 5.5| 7.59 $253| Not payable
93596| Right and left heart catheterization for congenital heart defect(s) including  image ing guidance by the proceduralist to advance the catheter to the target
zone(s); normal native connections| 5191/J1 $3,105| 6.84| 9.44 $314| Not payable
93597| Right and left heart catheterization for congenital heart defect(s) including  image ing guidance by the proceduralist to advance the catheter to the target
zone(s); abnormal native connections| 5191/J1 $3,105| 8.88| 12.33 $410| Not payable
Endomyocardial biopsy
93505| Endomyocardial biopsy| 5191/J1 $3,105| 4.12| 6.63 $221| 19.12 $636

HCPCS Codes

In the outpatient setting, when devices are used in combination with device- related procedures, hospitals report C codes. While the supply codes are not pa id separately from the procedure, the assignment of charges and report ing these  supply codes, identify device-related costs.

Transthoracic Echocardiogram (TTE)

In some cases, TTE may be performed in conjunction with an ICE-guide LAAO procedure to confirm cardiac function. The following codes are applicable for TTE procedures.

0| | | | Physician|
---|---|---|---|---|---
| | Outpatient
Hospital| | Facility| Non facility (OBL)
CPT
Code| CPT description| APC/
Status
Payment| Work
RVU| Total
RVU
Payment| Total
9
RVU
Payment|
C8923| Transthoracic echocardiography (TTE) with contrast, or without contrast followed by with contrast, realtime with image documentation (2D), includes Mode recording, when performed, complete, without spectra
l or color doppler echocardiography| 5573/S $763| NA| Facility only| Facility only| Facility only
C8924| Transthoracic echocardiography (TTE) with contrast, or without contrast followed by with contrast, realtime with image documentation (2D), includes Mmode recording when performed, follow-up or limited study| 5572/S $366| NA| Facility only| Facility only| Facility only
C8929| Transthoracic echocardiography (TTE) with contras or without contrast followed by with contrast, realtime with image documentation (2D), includes Mmode recording, when performed, complete, with  spectra l  doppler echocardiography, and with color flow doppler echocardiography| 5573/S $763| NA| Facility only| Facility only| Facility only
TTE without contrast
93306| 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| 5524/S $526| 1.46| 2.02 $67| Not payable
93307| Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectra l or color Doppler echocardiography| 5523/S $233| 0.92| 1.27 $42| Not payable
93308| Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited  study| 5523/S $233| 0.53| 0.73 $24| Not payable
Intraoperative TEE
CPT code 93355 bundles Doppler, color flow, 3D reconstruct ion & all echoism ing related to the Eva ulation, performance and completion of a  percutaneous structural heart intervention. This TEE procedure must be performed by a physician NOT performing the structural heart intervention.|
93355| Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg,TAVR, transcatheter pulmonary valve replacement, mitral valve repair,  paravalvular regurgitation repair, left atrial appendage occlusion/closure,  ventricular sept defect closure) (peri-and intra-procedural), Realtime image acquisition and documentation, guidance wit quantitative measurements,  probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration  of ultrasound contrast, Doppler, color flow, and 3D| N Packaged| 4.66| 6.58 $219| Not payable
Transesophageal Echocardiography (TEE)  CPT codes 93312-93318 include conscious sedation and should not be billed separately. CPT codes  76376 and 76377 and 93319 (3D echocardiography) should be billed in conjunct ion with the base code for the imaging procedure.|
TEE with contrast (hospital outpatient only)|
C8925| Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation  (2D) (with or without M-mode recording); including probe placement,  image acquisition, interop and report| 5573/S $763| NA| Facility only| Facility only
C8927| Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for monitoring purposes, including  probe placement, real time (2D) image acquisition and interpretation  leading to ongoing (continuous) assessment of (dynamically changing)  cardiac pumping function and to therapeutic measures on an immediate time basis| 5573/S $763| NA| Facility only| Facility only
TEE without contrast|
93312| Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement,  image acquisition, interpretation and report| 5524/S $526| 2.3| 3.11 $104| 7.06 $235|
93313|  ; placement of transesophageal probe only| 5524/S $526| 0.26| 0.33 $11| 0.33 $11|
93314| Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording) ; image acquisition,  interpretation and report only| N Packaged| 1.85| 2.60 $87| 6.77 $225|
93318| Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and
interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an
immediate time basis| 5524/S $526| 2.15| 2.97 $99| Not payable
93319| 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s)
(eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echo imaging)| N Packaged| 0.5| 0.69 $23| 1.66 $55|
93320| Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echo imaging); complete| N Packaged| 0.38| 0.52 $17| 1.52 $51|
93321|  ; follow-up or limited study (List separately in addition to codes for echocardiographic imaging)| N Packaged| 0.15| 0.21 $7| 0.75 $25|
93325| Doppler echocardiography color flow velocity mapping (List separately in  addition to code for echo) daring| N Packaged| 0.07| 0.09 $3| 0.70 $23|

Moderate Sedation

Moderate Sedation
Moderate sedation is separately reported with codes 99151-99157. Review documentation requirements prior to billing. CPT codes 93312-93318 include conscious sedation and should not be billed separately.

99151 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of interservice time, patient younger than 5 years of age| N         Packaged| 0.50| 0.71 $24| 1.82              $61
---|---|---|---|---
99152    ; initial 15 minutes of intraservice time, patient age 5 years or older| N         Packaged| 0.25| 0.36             $12| 1.51              $49
+99153 ; each additional 15 minutes intraservice time (List separately in addition to code for primary service)| N         Packaged| 0.00| 0.35 $12| 0.35              $12
99155 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age| N         Packaged| 1.90| 2.45             $82| 2.45 $82
99156    ; initial 15 minutes of intraservice time, patient age 5 years or older| N         Packaged| 1.65| 2.22             $74| 2.22              $74
+99157 ; each additional 15 minutes intraservice time (List separately in addition to code for primary service)| N         Packaged| 1.25| 1.76 $59| 1.76              $59

Structural Heart Disease Imaging

ICE and TEE Coding Questions & Tips 1,2

Can ICE and TEE be billed together?
This will depend on the procedure, provider, etc. We recommend consulting CPT guidelines, NCCI edits and payer requirements.
In general:

• TEE and ICE are not billable together if TEE is performed to confirm the findings of ICE.
• ICE is an add-on code that may only be performed in conjunction with primary procedures listed in this guide. TEE codes 93312 – 93318 and 93355 are considered primary codes. As long as there are no NCCI edits restricting TEE, and  documentation supports the procedure and medical necessity is met, TEE may be billable.

ICE and TEE

• Report CPT code 93355 (intraoperative monitoring) if utilized to measure and guide valvuloplasty or percutaneous valve replacement procedures. CPT code +93662 (ICE) is reported with mitral valvuloplasty (92987), PFO closure  (93580) and VSD closure (93581). ICE is not reported with transcatheter valve procedures involving valve placements, replacements, repair or other valvuloplasty’s.
• ICE is bundled with TMVI (code 0483T); TEE (93355) may be separately reportable if utilized.

ICE (+93662)

• ICE may be billed in addition to PFO or VSD closure if used to guide safe placement of the device and perform bubble studies to evaluate for residual shunting during the procedure.

TEE – Intraoperative Monitoring (CPT 93355)

• Report CPT code 93355 for TEE procedures during percutaneous structural heart interventions. Do not report CPT code 93319 with CPT code 93355 as 3D reconstructions are bundled with 93355.
• CPT code 93355 bundles Doppler, color flow, 3D reconstruction, and all echo imaging related to the evaluation, performance and completion of a percutaneous structural heart intervention.
• CPT code 93355 must be performed by a physician NOT performing the structural heart intervention.
• In order to bill CPT code 93355, TEE providers must meet the minimum threshold of BOTH placing the probe AND performing the interpretive study. Any other modalities, such as the use of Doppler or color flow mapping, will be  bundled into 93355. CMS has recently published a decision which allows the billing of 93355 only when it is performed by someone who is not also providing anesthesia on the case. In other words, an anesthesiologist can bill for  93355 as long as someone else, i.e., his/her partner, was providing the anesthesia.3

1. Zhealth Publishing, Cardiothoracic Surgery Coding Reference. 2021 and 2023
2. Zhealth Publishing, Diagnostic & Interventional Cardiovascular Coding Reference. 2021 and 2023.
3. TEE Documentation Requirements for Anesthesia Providers. https://www.anesthesiallc.com/publications/anesthesia-provider-news-ealerts/1389-tee-documentationrequirements-for-anesthesia-providers

TEE

• Coding for TEE is based on the same basic logic as radiology and ultrasound procedures: there is one code for placement of the probe (93313), one code for interpretation of the images (93314), and one for the comprehensive service  (93312). There are also codes for enhanced services: Doppler echocardiography pulsed wave and/or continuous wave with spectral display (93320), follow-up Doppler study (93321), color flow velocity mapping (93325), and 3D rendering with interpretation and reporting of CT, MRI, ultrasound or other tomographic modality (76376).
• While TEE is often billed in conjunction with anesthesia and invasive monitoring for cardiovascular cases, it may be performed as a stand-alone diagnostic service. If TEE is being performed by an anesthesiologist or a cardiologist as  a separate diagnostic service, it may require a MAC anesthetic, which is also separately billable.
• Codes 93312 and 93315 describe the complete procedure and include placement of the probe with supervision and interpretation of findings of the TEE.
• Codes 93313 and 93316 describe placement of the probe only. These would be used if two physicians were involved, one placing the probe and the other supervising the scanning and performing interpretation of the results.
• Codes 93314 and 93317 describe supervising the scanning and the interpretation only. Placement of the probe is performed by another physician.
• Hospitals should report either the code describing a complete procedure (96312 or 96315) or placement of only the probe (93313 or 93316). Codes 99314 and 93317 are reportable by hospitals but are not paid separately.
• Use CPT code 93318 for continuous TEE monitoring during surgical and other invasive endovascular procedures that requires constant monitoring of cardiovascular function and when used to assist in making therapeutic decisions during these procedures.
• CPT code +93319 was added effective 1/1/22. This add-on code describes the clinical work involved in 3D echocardiographic imaging and post-processing during TEE, or during TEE for congenital cardiac anomalies and includes the  assessment of cardiac structures and function. It is important to note that this is not an add-on code for CPT code 93355 since this code already includes 3D imaging for guidance of a structural intervention. CPT codes 76376  and 76377 are not add-on codes and are appropriate for reporting 3D-rendering services provided on a date separate from the base-imaging study.4

Ablation – 93656

• Effective 1/1/22, CPT code 93656 includes +93662 – do not bill separately for ICE.
  -77 Repeat Procedure by Another Physician 5
• This modifier defines a repeat procedure by another physician during the same patient encounter. It is approved for physician and hospital use. As an example, when a TEE procedure is repeated by another physician, the second  exam would require use of the -77 modifier and assumes that the second physician was aware this was a repeat procedure. For example, if a different physician acquires additional images, interprets, and prepares a report in addition  to the preoperative TEE, then 93314 (image acquisition, interpretation/report) or 93317 (congenital image acquisition, interpretation/report) can be reported with modifier -77. This indicates that the additional image  acquisition and interpretation was provided by a different physician. The medical record should reflect the medical necessity for repeating these procedures.

4. New Add-on CPT Code and Value for Three-Dimensional Echocardiography. https://www.asecho.org/newadd-on-cpt-code-and-value-for-three-dimensional- echocardiography/
5. American Society of Echocardiography. 2017 Coding and Reimbursement Newsletter. https://pdf4pro.com/amp/view/2017-coding-and-reimbursement- newsletter-1fe319.html

Third-party and References

Third-party sources

• 2016 CPT Changes, An Insider’s View
• 2017 CPT Changes, An Insider’s View
•  CPT Assistant
• 2024 ICD-10-CM and ICD-10-PCS: The Complete Official Codebook
• 2024 CPT-4 Professional Edition
• Zhealth Publishing
•  American Society of Echocardiography

References
CPT Copyright 2024 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/ or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.  The AMA assumes no liability for data contained or not contained herein.
Medicare Inpatient Prospective Payment System FY2024 Final Rule with Correction Notice. Table 5 CN. Payment rates assume full update amount for hospitals which have submitted quality data and hospitals have a wage index greater  than 1.
1 Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. CY2024 Final Rule, OPPS Addendum B, 122123.
– Status J1: Comprehensive APC – accounts for all costs and component services typically involved in the provision of the complete primary procedure; Status N: No separate APC payment. Packaged into payment for other services;  Status Q2: T-Packaged Codes – Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator “T” or “J1”. In other circumstances, payment is made through a separate APC payment.
Medicare Physician Fee Schedule. Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2024, Addendum B using MPFS 2024 conversion factor 33.2875 effective 030924 through 123124.

Questions
Contact Philips Reimbursement Resource Center
Phone: 858-720-4030
Email: IGTDReimbursement@philips.com

 ©2024 Koninklijke Philips N.V. All rights reserved.
Approved for external distribution.
March 2024
See page 2 for important information about the uses and limitations of this guide and page
Philips
3721 Valley Centre Drive, Suite 500
San Diego, CA 92130 USA
www.philips.com/IGTdevices

References

• Image-guided therapy | Philips
• TEE Documentation Requirements for Anesthesia Providers | Anesthesia Business Consultants

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