CPT® Code 93351

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional

The CPT® Code 93351 refers to a specific echocardiography procedure known as transthoracic echocardiography, which is performed in real-time and includes image documentation in two dimensions (2D). This procedure is comprehensive, as it encompasses M-mode recording when necessary, and is conducted during both rest and cardiovascular stress tests. The stress tests can be induced through various methods, including treadmill or bicycle exercise, or pharmacologically. The procedure is carried out under the supervision of a physician or another qualified healthcare professional, ensuring that the patient receives appropriate monitoring and care throughout the process.

During the procedure, if an electrocardiogram (ECG) is required for gating purposes, a three-lead ECG is connected to the patient. Initially, a baseline echocardiogram is obtained while the patient is at rest, allowing for a thorough evaluation of cardiac structure and dynamics. This evaluation is achieved through a series of real-time tomographic images, which are recorded either digitally or on videotape. The use of time-motion (M-mode) recordings is also incorporated as needed, facilitating dimensional measurements of the heart.

The assessment includes a detailed examination of various cardiac components, such as ventricular function, chamber sizes, wall thickness and motion, aortic roots, and cardiac valves. To capture comprehensive images, multiple transducer positions or orientations may be utilized, ensuring that images are obtained from various cardiac windows. Following the resting phase, the physician or qualified healthcare professional reviews the resting ECG and may order additional images to further investigate any identified abnormalities.

Once the exercise portion of the study begins, the patient's heart rate and blood pressure are continuously monitored. A continuous ECG may also be recorded during this phase. The procedure follows a staged stress protocol, with the patient's response to the stress being closely observed. Unless contraindicated, the exercise or pharmacological stress continues until the patient reaches their target heart rate or is unable to continue. Immediately after the stress component, images of the left ventricular wall motion are captured, which are then organized and submitted for review and interpretation.

Any abnormalities in cardiac structure or dynamics are noted, evaluated, and quantified. The physician compares the current study with any previous cardiac studies to identify changes. Finally, the physician or qualified healthcare professional provides an interpretation of the ECG along with a written report detailing the findings from the echocardiography procedure.