# Diagnosis for Echocardiogram Medical Necessity



## Chlrtrep (Oct 2, 2015)

I am not in diagnostic cardiology often however with the switch to ICD-10  I have noticed a few things going on..We have had many issues with the new ICD-10 codes triggering an ABN for Echocardiograms as well as many other procedures I am not sure if this is only specific to our system or if it is affecting everyone. Stating the diagnosis code listed requires an ABN .   One Diagnosis code in particular was mentioned by an echo tech.  Stating that all the Echocardiograms with the old ICD-9 code 785.2 Undiagnosed Cardiac Murmurs  listed as the reason for the exam is requiring an ABN. States that this is not a covered diagnosis.  The echo tech states the prior to OCT 1 this was an acceptable code.  I looked to see what this Icd-9 code Mapped to for ICD-10 and it is R01.1 Cardiac Murmur Unspecified.  When I pull the LCD for Echocardiograms it is not listed a diagnosis that supports medical necessity.  It only lists  R01.0 and R01.2.   When I entered r01.1 as a diagnosis it will triggers an ABN.   Is the diagnosis of cardiac murmur really not a covered diagnosis for an Echocardiograms?

Again in discussion with the cardiac tech she states that many echocardiograms procedures are ordered with the diagnosis of Cardiac murmur.  Does some have more information on what would be an appropriate ICD-10 for this procedure and what is the difference between r01.0 and r01.1 andr01.2   

Any guidance would be appreciated.


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