Advancing technology benefits the most to the early movers.
Myocardial strain imaging is a comparatively new technique in the cardiology space that now uses AI software and speckle-tracking techniques to provide a detailed look at the heart function. This helps cardiologists provide confident diagnoses and treatments to patients. Keep reading to get a detailed guide on this imaging technique and CPT reimbursements for it. We will be discussing the CPT codes and documentation procedures to secure reimbursements as well.
A Quick Overview of Myocardial Strain Imaging
Myocardial strain imaging is performed to measure the heart muscle deformation (shortening, lengthening, or thickening) during a cardiac cycle. It is a non-invasive procedure used to monitor the heart and diagnose cardiac diseases. Echocardiography performed using speckle-tracking technology is widely used to quantitatively assess the mechanics of heart muscles and detect any dysfunction. Strain imaging allows for the detection of heart muscle dysfunctions that are often missed by the conventional ECG procedure.
Clinical Applications of Myocardial Strain Imaging
Here is how cardiologists can enhance patient care with myocardial strain imaging technology:
Early Detection of Heart Dysfunction
Strain imaging can detect minor changes in the heart function that normal ECG can't. It detects cardiac dysfunctions before any apparent symptom, such as changes in ejection fraction, appear. This technology enables earlier identification of heart conditions, such as cardiomyopathy or cardiac ischemia. Keeping track of cardiac strain is crucial for patients undergoing cardiotoxic treatments as it allows doctors to make adjustments when needed.
Identification of Higher-Risk Patients
By carefully monitoring cardiac mechanics, cardiologists can identify patients having higher risks of adverse cardiac events.
Enhanced Monitoring
Detailed cardiac mechanics allow for personalized treatment strategies. It gives a deeper understanding of the progression or regression of disease.
Non-invasive and Safe
Myocardial strain imaging is performed using echocardiography or cardiac MRI. These procedures are non-invasive and well-tolerated by patients.
A Detailed Understanding of Cardiac Mechanics
With strain imaging, cardiologists can get detailed insights into heart functions that help them with accurately diagnosing and offering personalized treatments for conditions, such as hypertrophic cardiomyopathy and cardiac amyloidosis.
How Does Myocardial Strain Imaging Work?
Myocardial strain imaging echocardiogram uses ultrasound technology to measure the mechanical deformation of the heart muscle through speckle-tracking. Here is how this imaging technology is performed:
Patient preparation
Just like normal ECG, proper positioning of the patient and the application of electrodes are ensured before the test.
Image acquisition
2D echocardiographic images are obtained from multiple angles. This process usually takes around 30 minutes.
Tracking speckle motion
A specialized Speckle-Tracking Echocardiography (STE) software tracks the movement of speckles from frame to frame in the ultrasound video.
Strain calculation and analysis
The STE software calculates the motion of speckles by measuring the change in the distance between them over time. The change in the distance is called strain. This quantitative measurement of the strain is used to assess the function of the heart muscle.
Myocardial Strain Imaging vs Echocardiogram
Myocardial strain imaging and echocardiography are both procedures for assessing heart function, but they differ in their technology and the information they provide.
Echocardiography
Echocardiography is a non-invasive imaging technique that uses sound waves to create images of the heart. It provides information about the heart's size, structure, and overall pumping function. ECG can assess the heart's overall efficiency. However, it may not be sensitive enough to detect subtle changes in regional heart muscle function, especially in conditions like heart failure with preserved ejection fraction.
Myocardial Strain Imaging
Myocardial Strain Imaging is an advanced technique that measures the deformation of the heart muscle during its contraction and relaxation phases. It can detect slight changes in heart muscle function that may not be apparent in ECG. This is useful for identifying early signs of heart dysfunction. Additionally, myocardial strain imaging can provide information about diastolic function, which is often impaired in heart failure and other cardiac conditions.
Advancements in Myocardial Strain Imaging with AI
The process of analyzing myocardial strain imaging usually takes around 30 minutes. Doctors track speckles manually, so chances of human error are always present. However, today, advanced AI imaging systems can analyze the images within 15 seconds to give reproducible results. These systems automatically detect and analyze the speckles to deliver accurate test results quickly.
Understanding Reimbursements for Strain Imaging
Reimbursement rates vary when cardiologists offer strain imaging in addition to conventional ECG. We will be discussing details of how adding this technology to your practice can have an impact on reimbursement rates and how you can receive them.
A Correlation Between Clinical Value and Medical Bills
Offering myocardial strain imaging not only improves clinical value but also increases reimbursements. Cardiologists can receive additional reimbursements by mentioning this offering to the medical bill using proper protocols and carefully documenting it. We will discuss the documentation process in the coming sections.
Which Factors Influence Reimbursement Rates?
Here are some factors that influence reimbursement rates for myocardial strain imaging:
Payer Policies
Insurance policies vary depending on the insurance providers, such as Medicare, Medicaid, and private insurers. Medicare Part B reimburses for strain imaging, but Medicare Advantage and private plans cover these bills differently.
Proper Documentation
Careful documentation of the process and medical necessity is required to secure reimbursement. You must stay updated with the insurer's policies as they keep on changing.
CPT Code for Myocardial Strain Imaging
The CPT code for myocardial strain imaging is CPT code +93356. You must use it while billing for the procedure to secure reimbursements.
Facility Type
Reimbursement rates also depend on the healthcare setting where the procedure is performed, such as a hospital or a clinic.
Geographical Location
The geographical location of the health facility and the local market rates also influence the reimbursement rates.
Eligibility and CPT Documentation Criteria for Reimbursement
Let's explore which patients qualify for reimbursements, how to properly document the billing section, and how to follow the process:
Patients Who Qualify for CTP Code +93356 Reimbursement
In order to secure reimbursement, a myocardial strain imaging procedure should be necessary for the patient and must be documented as a necessity. It must be documented using the CPT code +93356 and performed according to the guidelines of the insurer.
Patients qualify for reimbursement under the following conditions:
Patients having conditions such as infiltrative cardiomyopathies, hypertrophic cardiomyopathy (HCM), and dilated cardiomyopathy (DCM) need strain imaging tests and hence, qualify for code +93356. Those at risk of such heart conditions also qualify for this code.
Patients under treatment involving cardiotoxic drugs, such as chemotherapy drugs, need constant monitoring of their heart health through strain imaging tests. So, such patients qualify for reimbursements.
Patients who have complex heart diseases require strain imaging tests for accurate diagnosis and treatments.
Documentation Procedure for CTP Coding
Here are some tips to properly document the billing for myocardial strain imaging:
In addition to mentioning the primary echocardiography procedure, use the add-on code for myocardial strain imaging while billing for your services. This code (+93356) specifies the speckle tracking technology.
To acquire reimbursements, it is important to mention that the procedure was a medical necessity. For this, cardiologists must document the clinical indication for the test.
Document the reasons for performing myocardial strain imaging by addressing some clinical conditions, such as evaluating left ventricular systolic function in patients with suspected or known cardiomyopathy. Cardiologists can also perform this test to assess myocardial injury in patients with a history of myocardial infarction. Monitoring the response to therapy in patients with heart failure is also a valid clinical reason to perform strain imaging.
Describe the techniques used, such as 2D speckle tracking echocardiography. Mention the structures assessed, like left ventricular walls. Document the parameters measured, such as longitudinal, radial, and circumferential strain.
Mention the quantitative values obtained from the strain test. Provide the interpretation of the results.
Follow the documentation standards and keep the document comprehensive to support the medical necessity of the test.
Steps to Take if Reimbursement Claims are Dismissed
If you've received a denial for your reimbursement claim, here are the steps you can take to address the issue:
Carefully read the denial letter to understand the reasons for the rejection. Common reasons include missing information, incorrect coding, lack of medical necessity, or exceeding coverage limits.
Verify all the information documented, including patient data, date of services, diagnostic procedures, and insurance information.
If all the data is accurate, you can file an appeal. Follow the instructions provided by the insurance company.
Speak to an insurance provider representative who can provide more information about the denial and the appeal process.
Recommended Ultrasound System to Perform Strain Imaging
If you are looking for a reliable ultrasound system that has the capability to perform myocardial strain imaging, we recommend using Philips EPIQ Elite. Released in 2019, this ultrasound system uses advanced imaging technologies to help you improve patient care and clinical practices. Philips EPIQ Elite is suitable for performing both pediatric and adult cardiac exams.
This system comes with an ergonomic design and supports 2D and 3D/4D imaging. Its 24-inch LCD monitor provides a wider viewing area with high resolution.
Heart Medical offers new, demo, and refurbished Philips EPIQ Elite ultrasound systems. You can consult with our team to choose the best system based on your clinical requirements and budget.
Conclusion
Myocardial strain imaging uses speckle-tracking technology that helps cardiologists examine the heart tissues to accurately diagnose cardiac dysfunction. It provides earlier diagnosis, helping cardiologists suggest timely treatment to prevent bigger issues from arising. This technique is a great way to closely monitor the heart mechanics and its reaction to certain medications. Due to the accurate diagnostic capabilities, strain imaging improves both patient care and clinical practices. Cardiologists can add this imaging service to their practice and secure reimbursements.
Heart Medical offers ultrasound systems, such as GE Vivid E9 and Philips EPIQ Elite, that have the capability to perform myocardial strain imaging. Contact our team today to get a consultation on choosing an ultrasound system.
FAQs
What is cardiac strain imaging?
Cardiac strain imaging measures the deformation of the heart muscle tissues during a cardiac cycle.
Is cardiac MRI the same as CMR?
Yes, cardiac MRI is the same as CMR. CMR is an abbreviation for Cardiovascular Magnetic Resonance. It's a type of MRI focusing on imaging the heart and blood vessels.
Can an MRI detect myocardial infarction?
Yes, MRI can detect myocardial infarction. It visualizes the extent of damage to the heart muscle, identifies areas of scar tissue, and assesses the overall impact of the heart attack.
Reviewed by Heart Medical Clinical Applications Team
Clinical and technical specialists ensuring accuracy and relevance across all Heart Medical content.