Q67.8 — Other congenital deformities of chest
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include appropriate patient identification and dates of service.
- Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- If the provider performing the TEE is different from the ordering/referring physician, the performing provider must retain hard copy documentation of test results and interpretation and copies of the ordering/referring physician's order.
Key Coverage Criteria
- 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.
- TEE may be used intraoperatively to guide assessment of left ventricular function and surgical decision-making.
- Transesophageal echocardiography (TEE) is medically necessary for examination of prosthetic heart valves, primarily mitral prostheses.
- TEE is medically necessary for assessment of patients with atrial arrhythmias (e.g., atrial fibrillation, atrial flutter) when test results will influence treatment decisions, including assessment for left atrial thrombus.
- TEE is indicated for detection or evaluation of aortic dissection.
- TEE is indicated for detection or evaluation of atrial septal defect.
6 Active Policies
A57179 — Billing and Coding: Transesophageal Echocardiogram
J09
L33756 — Transesophageal Echocardiogram
J09
AMBETTER-CP.MP.242 — Pulmonary Function Testing
AMBETTER-CP.MP.99 — Wheelchair Seating
AETNA-CPB-0452 — Noninvasive Positive Pressure Ventilation
Related Codes
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