Cardiology Coding Alert

Recognizing for the first time that the cost of the contrast agent used during echocardiography is separate from payment for the procedure itself, the Health Care Financing Administration (HCFA) has created a Q code, Q0188, that may be billed for the supply of contrast agents used during echocardiography.

The new HCPCS code is expected to become effective Oct. 1, 2000. Contrast echocardiography involves injecting an ultrasound-enhancing agent (Optison) into the patient, resulting in a clearer image of the left ventricular endocardial border. According to a policy statement by Trailblazer Health Enterprises, the Medicare Part B carrier in Texas, the service may augment diagnosis and treatment of selected patients ... In certain circumstances, myocardial contrast echocardiography (MCE) might replace radionuclide angiography or stress SPECT testing.

Until the new code was announced, the only HCPCS code that actually described the supply was S8060. S-codes are not covered by Medicare, although some private carriers may reimburse for them.

Medicare policies on MCE vary considerably from state to state. Local Medicare carriers still will have the authority to determine the circumstances under which coverage for the new J-code will be permitted.

Contrast-enhanced echocardiography is a new technique that can aid in the treatment of some types of heart disease by giving the cardiologist a better view of the left ventricle than would be afforded by a routine echo. Although Optison, the contrast agent typically used for such echocardiograms, received FDA approval on Dec. 31, 1997, both Medicare and commercial carriers have been slow to agree to reimburse for this service or to issue policy guidelines.

The American College of Cardiology (ACC) has urged HCFA to cover the use of echocardiography contrast agents and to establish a uniform, reasonable reimbursement policy. This service can contribute significantly to the diagnosis and treatment of cardiovascular disease, argues the ACC, which is urging HCFA to end the policy disarray among its local carriers.

MCE is particularly useful for patients undergoing a stress echo. The service most frequently is used during the evaluation of patients for myocardial and ischemic disease.

Some carriers, such as CIGNA Healthcare, the Medicare Part B carrier in Tennessee, North Carolina and Iowa, consider all [contrast-enhancing echocardiography] agents used in the performance of a procedure ... included in the practice expense reimbursement for the procedure.

Meanwhile, carriers such as HGSA Administrators, Empire Medicare Services, the Part B carrier in New Jersey and parts of New York, including New York City, have paid for Optison since fall 1999. Both carriers instructed physicians to use unlisted injection code 90799 (unlisted therapeutic, prophylactic or diagnostic injection) to report the Optison use, whereas Trailblazer in Texas requests that providers use HCPCS code J3490 (unclassified drugs).