Cardiology Coding Alert

Myocardial contrast echocardiography (MCE), sometimes referred to as contrast-enhanced echocardiography, is a relatively 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 the federal Food and Drug Administration (FDA) approved Optison, the contrast agent typically used for such echocardiograms, on Dec. 31, 1997, both Medicare and commercial carriers have been slow to agree to reimburse this service or issue policy guidelines.

Consequently, coding and payment for this service remain unclear in many parts of the country. And even in states where the local Medicare carrier has issued a policy on the use of Optison, the policies differ widely. For its part, the Health Care Financing Administration (HCFA) has yet to issue a policy statement, which means the local Medicare carriers have free rein to determine payment as they see fit. As a result, policies range from outright denial or rolling the service in with the echo, to paying out the drug portion through an HCPCS code or using an unlisted code to bill for the service.

The procedure itself is straightforward. An ultrasound-enhancing agent (Optison) is injected 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, MCE might replace radionucleide angiography or stress SPECT testing.

MCE is particularly useful for patients undergoing a stress echo, according to a similar policy statement from Xact Medicare Services, the Pennsylvania carrier. It is used most frequently during the evaluation of patients for valvular and ischemic disease.

Medicare Coding and Reimbursement Trends

Last year, the American College of Cardiology (ACC) urged HCFA officials to cover the use of echocardiography contrast agents, noting that this service can contribute significantly to the diagnosis and treatment of cardiovascular disease. ACC also asked HCFA to end the policy disarray among its local carriers.

HCFA should establish a uniform, reasonable reimbursement policy for echocardiography contrast agents, according to the ACC. To date, coverage and payment policies for contrast agents have varied widely among state Medicare carriers. Some are inappropriately denying coverage of contrast agents altogether. These denials are based on the inaccurate belief that the cost of echocardiography contrast agents is included in the current allowances for echocardiography services under the Medicare physician fee schedule. In fact, HCFA has not accounted for these agents in the current echocardiography relative value units; however, the agency is seriously considering such a bundling approach as part of the refinement process [...]