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ICD-10-CM S25.492S, Other specified injury of left pulmonary blood vessels, sequela | No Prior Auth

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`S25.492S`, Other specified injury of left pulmonary blood vessels, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

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.

A covered TEE must include a complete written interpretation/report by the performing physician, and this report must be available upon request.

The medical record must document medical necessity including relevant history, physical exam, results of pertinent diagnostic tests/procedures, and reasons for repeat testing.

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.
Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.

15 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

A56758, Billing and Coding: Non-Invasive Vascular Studies

J6

NGS-J6-L33579, Transesophageal Echocardiography (TEE)

J6

A52868, Billing and Coding: Transesophageal Echocardiography (TEE)

J6

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

J6

NGS-J6-L33627, Non-Invasive Vascular Studies

J6

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

J6

NGS-JK-L33627, Non-Invasive Vascular Studies

JK

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

JK

NGS-JK-L33579, Transesophageal Echocardiography (TEE)

JK

A56697, Billing and Coding: Non-Invasive Vascular Studies

A56625, Billing and Coding: Echocardiography

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A57326, Billing and Coding: Electrocardiograms

Related Codes

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