Echocardiogram (Heart Ultrasound)

What it is

An echocardiogram is an ultrasound of the heart. A sonographer presses a handheld probe against the chest and upper abdomen, and the echoes coming back from the moving heart are assembled into live images of the chambers, the walls, and the valves. Doppler adds a second layer: it measures the speed and direction of blood moving through the heart, which is how leaking or narrowed valves are assessed. This code describes the complete study done from outside the chest — what clinicians call transthoracic. A transesophageal study, where a probe is passed down the throat for a closer view, is a different procedure with a different code and a much different price.

Why it is done

• To measure how well the heart is pumping, and to look at the size and thickness of its chambers and walls
• To evaluate a heart murmur, or a valve known to be leaking or narrowed
• To look for damage after a heart attack, or for fluid around the heart
• To follow a known heart condition over time, or to check the heart before or during treatment that can affect it

What to expect

There is nothing to prepare for a standard transthoracic study. Patients undress from the waist up, lie on their side or back, and small electrodes are placed to track the heartbeat alongside the images. The sonographer spreads gel on the chest and moves the probe across it, pressing firmly in places and asking for held breaths. It is not painful, though the pressure can be uncomfortable over the ribs. The study generally takes 30 to 60 minutes. A cardiologist reads the images afterward and sends a report; the sonographer doing the scan will usually not give results on the spot.

Questions worth asking

• Is this a complete study, a limited one, or a stress echo? They are different codes at different prices.
• Will there be two charges — one for performing the scan and one for the cardiologist's reading — and is each one in network?
• Is it being done in a hospital department or in a cardiology office? A hospital setting often adds a facility fee that an office visit does not.
• Is contrast being used to improve the images, and is that billed on top?