B95.61 — Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
Key Coverage Criteria
- CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
- When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
- For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
- Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
- Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
- Reconstructive plastic surgery is covered when performed for therapeutic purposes such as treatment of severe burns, facial repair following auto trauma, or similar reconstructive/therapeutic surgery.
8 Active Policies
L33756 — Transesophageal Echocardiogram
J09
A57179 — Billing and Coding: Transesophageal Echocardiogram
J09
A56505 — Billing and Coding: Transesophageal Echocardiography (TEE)
J12
L35016 — Transesophageal Echocardiography (TEE)
J12
L35163 — Plastic Surgery
Related Codes
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