Ask Dr. Z

Please advise how to code for an epicardial echo. I’m baffled because the procedure has been around since the 1970s, and in 2007 ASE published an article on the growing importance of them, so epicardial echos are well-established yet I cannot find any mention of it in CPT or your reference books.

The case: A baby is in the OR for surgery to correct ASD. Before closing the chest, a pediatric cardiologist (not a surgeon) performs a limited epicardial echocardiogram with spectral and color flow Doppler. How do we report this service appropriately? Unlisted, 93799? Or is there a better code? I do not believe 76998 is appropriate here because it is not for guidance; it is done at the end of case to evaluate function after surgery. Or does that count as guidance?

If we must use unlisted, how does the work compare to TEE? Not sure how to go about pricing it, we didn’t have to place a probe down a throat so that seems like less work, but carefully probing over the surface of the heart might be more work? I don’t know.