Name of the Procedure:

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography (C8923)

Common name(s): Echocardiogram, Heart ultrasound
Technical/Medical terms: Transthoracic echocardiography, TTE, 2D echocardiography, M-mode echocardiography

Summary

Transthoracic echocardiography (TTE) is a non-invasive imaging procedure that uses ultrasound waves to create detailed images of the heart. It can be performed with or without the use of a contrast agent to enhance image quality. This particular procedure (HCPCS C8923) does not include spectral or color Doppler echocardiography.

Purpose

Medical Conditions/Problems:

• Heart valve disease
• Cardiomyopathy
• Congenital heart defects
• Pericardial disease

Goals/Expected Outcomes:

• Obtain detailed images of the heart’s structure and function
• Diagnose or rule out heart conditions
• Guide treatment decisions

Indications

Specific Symptoms/Conditions:

• Shortness of breath
• Chest pain
• Palpitations
• Unexplained fatigue
• Heart murmur

Patient Criteria:

• Patients with suspected or known heart conditions
• Pre-surgical or post-surgical heart assessment

Preparation

• Patients may be advised to refrain from eating for a few hours before the procedure.
• Medications may need adjustment, as instructed by the healthcare provider.
• Wear comfortable clothing and potentially remove any jewelry.

Diagnostic Tests:

• Recent blood work
• Previous echocardiograms or other imaging studies

Procedure Description

1. The patient lies on an examination table.
2. A technician applies a conductive gel to the chest.
3. A transducer (ultrasound probe) is moved across the gelled area to capture images.
4. In the case of contrast use, a contrast agent is injected intravenously.
5. Real-time 2D images of the heart are recorded. M-mode recording may also be performed to measure cardiac structures.
6. The procedure is non-invasive and painless, typically without the need for anesthesia but may include mild sedation if the patient is anxious.

Tools/Equipment:

• Ultrasound machine
• Transducer probe
• Conductive gel
• Intravenous catheter and contrast agent (if used)

Anesthesia/Sedation:

• Usually not required; mild sedation if necessary

Duration

Approximately 30-60 minutes.

Setting

The procedure is typically performed in a hospital, outpatient clinic, or a specialized imaging center.

Personnel

• Cardiologist or radiologist
• Ultrasound technician
• Nursing staff (if contrast is used)

Risks and Complications

Common Risks:

• Minor discomfort from lying still
• Possible allergic reaction to contrast agent

Rare Risks:

• Infection at injection site
• Arrhythmias induced by the procedure

Management:

• Close monitoring during and after the procedure
• Immediate medical intervention if complications arise

Benefits

• Non-invasive and painless with no radiation exposure.
• Provides comprehensive visualization of heart structure and function.
• Can guide effective management and treatment of cardiac conditions. ##### Realization Time:
• Immediate results and interpretation

Recovery

• No downtime; patients can resume normal activities immediately.
• Follow-up instructions provided depending on the findings.
• Possible consultation with a cardiologist for further treatment based on results.

Alternatives

Other Options:

• Transesophageal echocardiography (TEE)
• Magnetic Resonance Imaging (MRI) of the heart
• Cardiac CT scan

Pros and Cons:

• TEE: More invasive but provides clearer images
• MRI: No radiation, but more expensive and time-consuming
• Cardiac CT: Offers detailed images with some exposure to radiation

Patient Experience

During the procedure, the patient might feel slight pressure from the transducer and coolness from the gel. Post-procedure, there may be some minor discomfort at the IV site if contrast was used. Pain management is generally not needed, given the non-invasive nature of the test.