How To Use CPT Code 93356

CPT 93356 refers to myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics, performed in addition to standard echocardiography. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 93356.

1. What is CPT 93356?

CPT 93356 is a medical procedure code that describes myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics. This procedure is performed in addition to standard echocardiography to provide a more comprehensive evaluation of the heart’s function and mechanics. The primary purpose of this procedure is to assess myocardial strain, which refers to the percentage of change in the length (stretch) of myocardial fibers, typically of the left ventricle, that occurs after the application of stress.

2. 93356 CPT code description

The official description of CPT code 93356 is: “Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging)”.

3. Procedure

The 93356 procedure involves the following steps:

1. The patient undergoes standard echocardiography.
2. During the echocardiography, the provider performs speckle tracking of cardiac motion from image intensities to analyze left ventricular deformation.
3. Speckle tracking echocardiography (STE) captures the speckled pattern of image contours and tissue textures in a region of interest.
4. The patient is asked to hold their breath, and images are captured during multiple beats of regular heart rhythm.
5. These acoustic markers are tracked from end-diastole to end-systole and show longitudinal, radial, and circumferential displacement.
6. A speckle-tracking algorithm analyzes the data and quantifies the degree of myocardial strain.

4. Qualifying circumstances

Patients eligible to receive CPT code 93356 services are those who require a more detailed assessment of their heart’s function and mechanics, in addition to standard echocardiography. This may include patients with hypertensive heart disease, coronary artery disease, left ventricular dysfunction caused by valvular heart disease or heart failure, and other conditions that may affect the heart’s function.

5. When to use CPT code 93356

It is appropriate to bill the 93356 CPT code when the provider performs myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics in addition to standard echocardiography. This procedure is typically performed when a more comprehensive evaluation of the heart’s function and mechanics is necessary, such as in cases of hypertensive heart disease, coronary artery disease, left ventricular dysfunction caused by valvular heart disease or heart failure, and other conditions that may affect the heart’s function.

6. Documentation requirements

To support a claim for CPT 93356, the following information should be documented:

• Indication for the procedure, including the patient’s medical history and any relevant diagnostic findings.
• A detailed description of the procedure, including the use of speckle tracking-derived assessment of myocardial mechanics and any additional echocardiographic imaging performed.
• Results of the myocardial strain imaging, including any measurements and calculations derived from the speckle tracking analysis.
• Interpretation of the results, including any clinical implications and recommendations for further evaluation or treatment.

7. Billing guidelines

When billing for CPT code 93356, it is important to follow the appropriate guidelines and rules. This code is an add-on code and must be reported with an appropriate echocardiographic procedure code, such as 93303 through 93355. Additionally, some payers may consider myocardial strain imaging using speckle tracking echocardiography as experimental, investigational, or not medically necessary, so it is crucial to check the payer’s LCD to determine when this procedure is covered.

8. Historical information

CPT 93356 was added to the Current Procedural Terminology system in 2019. There have been no updates to this code since its addition.

9. Similar codes to CPT 93356

Five similar codes to CPT 93356 include:

• CPT 93303: This code describes transthoracic echocardiography for congenital cardiac anomalies, which is a different type of echocardiography procedure.
• CPT 93306: This code refers to a complete transthoracic echocardiogram, which is a more comprehensive echocardiography procedure that may include myocardial strain imaging.
• CPT 93350: This code describes an echocardiography procedure performed during stress testing, which is a different context for echocardiography.
• CPT 93351: This code refers to an echocardiography procedure performed during stress testing, including the supervision, interpretation, and report, which is a more comprehensive service.
• CPT 93355: This code describes an echocardiography procedure for guidance of transcatheter intracardiac or great vessel structural interventions, which is a different type of echocardiography procedure.

10. Examples

Here are 10 detailed examples of CPT code 93356 procedures:

1. A patient with hypertensive heart disease undergoes myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics in addition to standard echocardiography to evaluate the extent of left ventricular dysfunction.
2. A patient with a history of coronary artery disease undergoes myocardial strain imaging to assess the impact of the disease on their heart’s function and mechanics.
3. A patient with valvular heart disease undergoes myocardial strain imaging to evaluate the impact of the disease on left ventricular function.
4. A patient with heart failure undergoes myocardial strain imaging to assess the severity of left ventricular dysfunction and guide treatment decisions.
5. A patient with suspected cardiac amyloidosis undergoes myocardial strain imaging to evaluate the impact of the disease on their heart’s function and mechanics.
6. A patient undergoing chemotherapy for cancer undergoes myocardial strain imaging to monitor for potential chemotherapy-induced cardiotoxicity.
7. A patient with a history of heart transplant undergoes myocardial strain imaging to assess for potential transplant rejection.
8. A patient with sarcoidosis undergoes myocardial strain imaging to evaluate the impact of the disease on their heart’s function and mechanics.
9. A professional athlete undergoes myocardial strain imaging to differentiate between pathologic and physiologic left ventricular hypertrophy.
10. A patient with suspected left ventricular dyssynchrony undergoes myocardial strain imaging to assess the extent of the disturbance in the timing of left ventricular function.