Stress Echocardiography 93350, 93351 – Care to Care's Clinical Criteria

1 Major symptom or complaint presented as primary indication

1.1 Chest pain

1.2 Dizziness

1.3 Fatigue

1.4 Hypoxemia

1.5 Initial evaluation of known or suspected heart failure (systolic or diastolic) or cardiomyopathy

1.6 Irregular heartbeat

1.7 Myocradial infarction (heart attack)

1.8 Palpitations

1.9 Presyncope (lightheadedness)

1.10 Shortness of breath (dyspnea)

1.11 Stroke

1.12 Swelling of the ankles and feet (edema)

1.13 Syncope (fainting)

1.14 Transient ischemic attack (TIA)

2 Working diagnosis or rule out presented as primary indication

2.1 Cardiomyopathy (restrictive, infiltrative, dilated, hypertrophic), suspected

2.2 Coronary artery disease, suspected

2.3 Heart failure, suspected

3 Abnormal physical exam finding presented as primary indication

3.1 Arrhythmia

3.2 Hypoxemia

3.3 Swelling of the ankles and feet (edema)

4 Abnormal lab or imaging presented as primary indication

4.1 Inconclusive or inadequate transthoracic echocardiogram (TTE) or Transesophageal echocardiogram (TEE)

4.2 Left ventricular systolic dysfunction

4.3 Low left ventricular ejection fraction (LVEF) (<50%)

4.4 Severe aortic stenosis (AS)

5 Significant prior medical history presented as primary indication

5.1 Cardiomyopathy (restrictive, infiltrative, dilated, hypertrophic)

5.2 Congenital heart disease

5.3 Coronary artery disease

5.4 Heart failure

5.5 Left ventricular systolic dysfunction

5.6 Mitral valve repair with suspected dysfunction

5.7 Percutaneous mitral valve repair

5.7.1 Prior to percutaneous mitral valve repair

5.7.2 Suspicion of post-procedural valve dysfunction

5.8 Pulmonary hypertension

5.9 Valvular heart disease

5.9.1 Assessment of pulmonary pressures during stress in patient with severe asymptomatic valve regurgitation prior to pregnancy

5.9.2 Asymptomatic aortic stenosis (AS)

5.9.2.1 Re-evaluation every 1 year

5.9.3 Chronic mitral regurgitation (MR) (stages B to D)

5.9.4 Mitral stenosis (MS) or mitral regurgitation (MR) and discrepancy between clinical symptoms and resting echocardiogram findings

5.9.5 Moderate or severe aortic regurgitation (AR)

5.9.6 Moderate or severe aortic stenosis (AS), (stages B and C)

6 References

6.1 David S. Bach, American College of Cardiology, 9/1/17
2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease

6.2 John U. Doherty et al., Journal of the American College of Cardiology (JACC Journals), 2017 Sep, 70 (13) 1647-1672
ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons

6.3 American College of Cardiology , 1/7/19
New AUC: Multimodality Imaging in Assessing Cardiac Structure and Function in Structural Heart Disease

6.4 John U. Doherty et al., Journal of the American College of Cardiology (JACC Journals), 2019 Feb, 73 (4) 488–516
ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons

6.5 Debabrata Mukherjee, American College of Cardiology, 1/7/19
2019 Appropriate Use Criteria for Multimodality Imaging in Nonvalvular Heart Disease

6.6 Singh A and Ward RP, Current Cardiology Reports, 2016 Sep;18(9):93
Appropriate Use Criteria for Echocardiography: Evolving Applications in the Era of Value-Based Healthcare