A42.7 — Actinomycotic sepsis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of the qualifications of personnel performing TEE should be available upon request.
- For diagnostic TEEs, report the test result if known; if not known, report the symptoms that prompted the test.
- When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
- Maintain copies of image documentation (paper or tape) and include all appropriate measurements; Doppler interrogations must state modes used and provide qualitative and quantitative data.
Key Coverage Criteria
- Transesophageal echocardiography (TEE) is indicated when transthoracic echocardiography (TTE) provides inadequate visualization of cardiac anatomy for structures normally visualized by TTE; report ICD-10-CM R93.1 or R93.8 as the primary diagnosis and the cardiac abnormality as a secondary diagnosis.
- TEE is indicated when performed during an open chest (intraoperative) procedure; report ICD-10-CM Z01.89 as the primary diagnosis and the reason for the surgical procedure as the secondary diagnosis.
- Use CPT 93315, 93316, or 93317 for evaluation of congenital cardiac anomalies (these codes are reserved for congenital anomalies only).
- CPT 93355 is indicated to report TEE services performed during transcatheter intracardiac therapies and includes probe passage, image acquisition/interpretation, intra-procedural manipulation to guide sizing/placement, assessment of adequacy and complications, and final report.
- 3D imaging (CPT 93319) and CT/MR fusion or related add-on imaging (CPT 76376, 76377) are allowable when billed as add-on services with their listed base TEE imaging codes.
- Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
20 Active Policies
L40181 — Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
A52868 — Billing and Coding: Transesophageal Echocardiography (TEE)
J06
A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)
J06
A59105 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
Related Codes
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