Coding for Contrast

Updated February 2018

  1. How is a stress echocardiogram with contrast reported by the physician when performed in the office setting?
    Report the stress echocardiogram (93350 or 93351) with contrast administration code 93352. In addition, report the applicable contrast agent codes (Q9955, Q9956, Q9957, or Q9950).  Per the NCCI manual and correct coding edits, Medicare does not allow separate reporting for the IV insertion or injection procedure.
  2. Can physicians report code 93352 contrast administration for stress echo for procedures performed in the hospital setting?
    Physicians may report code 93352 for procedures performed in the hospital and office setting.93352  Use of echocardiographic contrast agent during stress echocardiography (list separately in addition to code for primary procedure)
  1. How are contrast echocardiography procedures reported by the hospital?
    Medicare has established an entire family of “HCPCS” echocardiography “C” codes for reporting by the hospital when an outpatient contrast echo procedure is performed (see Table 1).  In addition to reporting the contrast procedure, the hospital should report the applicable contrast agent “Q” codes (Q9955, Q9956, Q9957, or Q9950.  Per the NCCI manual and correct coding edits, Medicare does not allow separate reporting for the IV insertion or injection procedure. Private payers may or may not use these “HCPCS” echocardiography “C” codes.  Check with payers.
  2. What are the “HCPCS” codes for Stress Echocardiography with Contrast?
    There are 8 “HCPCS” Level II “C” codes that bundle the contrast agent and the echocardiography procedure.  Specifically, all types of echocardiography procedures (e.g. TTE, TEE, stress echo) may be reported to describe a contrast enhanced echocardiography procedure. Hospitals that perform echocardiograms contrast should continue to use the existing Level I CPT codes (93303-93351) for these services.

Table 1. Medicare HCPCS “C” codes and abbreviated descriptors for contrast enhanced echocardiography procedures for hospital use only

HCPCS    Abbreviated Descriptors
C8921 TTE with contrast for congenital cardiac anomalies; complete
C8922 TTE with contrast for congenital cardiac anomalies; follow-up or limited study
C8923 TTE with contrast, (2D) with or without m-mode recording; complete
C8924 TTE with contrast, or without contrast followed by with contrast, (2D) with or without m-mode recording; follow-up or limited study
C8925 TEE with contrast, or without contrast followed by with contrast, (2D) (with or without m-mode recording); including probe placement, image acquisition, interp and report
C8926 TEE with or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interp and report
C8927 TEE with contrast or without contrast followed by with contrast, for monitoring purposes, including probe placement, 2-D image acquisition and interp leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis
C8928 TTE with contrast, or without contrast followed by with contrast, (2D), with or without m- mode recording, during rest and CV stress test using treadmill, bicycle exercise and/or  pharmacologically induced stress, with interp/report
C8929  TTE with contrast, or without contrast followed by with contrast, (2D), includes m-mode  recording, when performed, complete, with spectral Doppler echocardiography, and  with color flow Doppler echocardiography
C8930  TTE, with contrast, or without contrast followed by with contrast, (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill,  bicycle exercise and/or pharmacologically induced stress, with interp/report; including performance of continuous electrocardiographic monitoring, with physician supervision

Guidance

  • Hospitals are instructed by Medicare to bill for any type of echocardiography (e.g. TTE, TEE, SE) with contrast using the applicable HCPCS code(s) above. Private payers may also use these codes.
  • Report the supply of the contrast agent; selecting the applicable HCPCS contrast codes Q9955-Q9957 which are assigned by the specific type of contrast used. All other echocardiography contrast agents not described by Q9955, Q9956, Q9957, or Q9950 shall be reported with A9700 (echo contrast agent).
  • Q9955 injection, perflexane lipid microspheres, per ml
  • Q9956 injection, octafluoropropane microspheres, per ml
  • Q9957 injection, perflutren lipid microspheres, per ml
  • Q9950 Injection, sulfur hexafluoride lipid microspheres, per ml
  • Do not report the IV insertion (36000) or injection procedure (96374) to report the injection of contrast during echocardiography.
  • Report applicable Doppler echocardiography procedures (93320-93325), if clinically indicated.

Common hospital outpatient coding scenarios for contrast echocardiography for Medicare patients

Contrast-enhanced stress echocardiogram C8930 + contrast Q code
Contrast-enhanced TTE with Doppler and color Doppler C8929 + contrast Q code

 

  1. What is the code for myocardial contrast perfusion?

0439T Myocardial contrast perfusion echocardiography, at rest or with stress, for assessment of myocardial ischemia or viability (list separately in addition to code for primary procedure)

The CPT instruction allows reporting with TTE and stress echo primary procedures.
Use 0439T in conjunction with 93306. 93307, 93308, 93350, 93351. 

Code 0439T is an add-on Category III CPT code, which does not have any assigned relative value units (RVU’s). Physician payment is at the discretion of the payer.  Medicare does not separately pay for this procedure when done in the hospital setting.

This reference is for information purposes only. No guarantee of payment is stated or implied. It is the responsibility of the health care provider to properly code and to seek reimbursement for rendered medically appropriate and necessary services

CPT Copyright 2017 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.