Reporting and coding for an echocardiogram with intravenous contrast for injectable suspension

Q.

How do we report echocardiogram with intravenous LUMASON^® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use in a physician’s office?

A.

When billing for a Medicare patient, you would report the regular echocardiogram code appropriate to the study that was performed, such as CPT^® code 93306 for a complete echo with color and spectral Doppler. In addition to the code for the echocardiogram, you would report the HCPCS code for the contrast – Q9950 for LUMASON. This is reported per ml given on one line. To report any discarded LUMASON, report Q9950 -JW times the amount discarded from the 5 ml vial on a second line. The physician should document in the patient’s record the amount discarded.

The codes and full descriptions are as follows:

93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M- mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

Q9950 Injection, sulfur hexafluoride lipid microspheres, per ml

When performing this procedure in a Hospital Outpatient Setting, there are a series of C Codes that may be used, C8921–C8930. The C Code equivalent of 93306 is C8929. 

The full description is as follows:

C8929: Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography

Some commercial insurers may cover the C Codes in the physician’s office setting, please check with your payors to see how they would like the procedure to be billed. 

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INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

LUMASON^® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use

Indications

LUMASON^® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use is an ultrasound contrast agent indicated for use:

• in echocardiography to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border in adult and pediatric patients with suboptimal echocardiograms
• in ultrasonography of the liver for characterization of focal liver lesions in adult and pediatric patients
• in ultrasonography of the urinary tract for the evaluation of suspected or known vesicoureteral reflux in pediatric patients

 

IMPORTANT SAFETY INFORMATION

WARNING: SERIOUS CARDIOPULMONARY REACTIONS

Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following the injection of ultrasound contrast agents, including sulfur hexafluoride lipid microspheres. Most serious reactions occur within 30 minutes of administration.

• Assess all patients for the presence of any condition that precludes administration
• Always have resuscitation equipment and trained personnel readily available

 

Contraindications

LUMASON (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use is contraindicated in patients with known or suspected hypersensitivity to sulfur hexafluoride lipid microsphere or its components, such as polyethylene glycol (PEG).

Warnings

Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or shortly following administration of ultrasound contrast agents, including LUMASON. Always have cardiopulmonary resuscitation personnel and equipment readily available prior to LUMASON administration and monitor all patients for acute reactions.

Post-marketing hypersensitivity reactions, including serious hypersensitivity reactions, have been observed during use or shortly following LUMASON administration. These reactions may occur in patients with no history of prior exposure to sulfur hexafluoride lipid-containing microspheres. LUMASON contains PEG. There may be increased risk of serious reactions including death in patients with prior hypersensitivity reaction(s) to PEG.

Systemic embolization may occur in patients with cardiac shunts. Assess patients with cardiac shunts for embolic phenomena following LUMASON administration.

There is a risk of ventricular arrhythmia related to high mechanical index in patients administered LUMASON. LUMASON is not recommended for use at mechanical indices greater than 0.8.

The most common adverse reactions (incidence ≥ 0.5%) are headache (1%) and nausea (0.5%).

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please click here for full Prescribing Information for LUMASON ultrasound contrast agent, including BOXED WARNING on Serious Cardiopulmonary Reactions.

LUMASON is manufactured for Bracco Diagnostics Inc., Monroe Township, NJ 08831 by Bracco Suisse S.A., Plan-les-Ouates Geneve, Switzerland (LUMASON lyophilized powder vial-25 mg lipid-type A/60.7 sulfur hexafluoride gas); Vetter Pharma-Fertigung GmbH & Co. KG, 88212 Ravensburg, Germany (Sodium Chloride 0.9% Injection, USP); B. Braun Melsungen AG, 34212 Melsungen, Germany (Mini-Spike). 

LUMASON is a registered trademark of Bracco Diagnostics Inc.