How do I write a prescription for an echocardiogram (echo) 2D?

How to Write a Prescription for a 2D Echocardiogram

A prescription for a 2D echocardiogram should include the procedure name "Transthoracic Echocardiogram (TTE)" or "2D Echocardiogram," the primary diagnosis code (typically ICD-10 code I10 for hypertension or other relevant cardiac indication), specific clinical indication for the test, and any relevant clinical history or symptoms that justify the examination. 1

Essential Components of the Prescription

Procedure Name

• Write "Transthoracic Echocardiogram (TTE)" or "2D Echocardiogram" as the procedure name 2
• You may specify "2D Echo with Doppler" if hemodynamic assessment is needed 3

Primary Diagnosis Code

• Use ICD-10 code I10 (Essential hypertension) as the primary diagnosis code when evaluating for hypertension-mediated organ damage 1
• Include R94.31 (Abnormal ECG) if the ECG shows left ventricular hypertrophy or other abnormalities 1
• Add I51.7 (Cardiomegaly) if cardiac enlargement is suspected clinically or on chest X-ray 1
• Use R06.02 (Shortness of breath) if the patient has dyspnea suggesting diastolic dysfunction 1
• Include I11.0 (Hypertensive heart disease with heart failure) if there are clinical signs or symptoms of heart failure 1

Clinical Indication

• Document the specific reason for ordering the test, such as "to assess for hypertension-mediated cardiac damage" or "evaluation of left ventricular function" 1
• For acute presentations, specify "evaluation of chest pain" or "assessment of dyspnea" 4, 5
• Include "assessment of cardiac chamber size and function" or "evaluation of valvular heart disease" as appropriate 2

Documentation Requirements

Patient Information

• Include patient demographics: age, height, and weight (needed for body surface area calculations) 6
• Document current blood pressure readings at the time of prescription 1
• Record heart rate and rhythm status 6

Clinical Context

• Document the duration and severity of hypertension (e.g., "chronic uncontrolled hypertension") 1
• List current antihypertensive medication regimen 1
• Note any relevant symptoms: dyspnea, palpitations, chest discomfort, syncope 1
• Include pertinent physical exam findings: irregular pulse, cardiac murmur, elevated jugular venous pressure 1

Specific Clinical Scenarios

For Hypertension Evaluation

• Echocardiography is strongly recommended in patients with chronic uncontrolled hypertension despite combination therapy to assess for target organ damage 1
• The test is particularly indicated in young patients (≤18 years) with hypertension 1
• Use for assessment of left ventricular hypertrophy, which is an independent predictor of cardiovascular events 1

For Suspected Heart Failure

• Order when there are clinical signs or symptoms of heart failure in hypertensive patients 1
• Include assessment of both systolic and diastolic function 6
• Request evaluation of left ventricular ejection fraction and wall motion abnormalities 4

For Acute Chest Pain

• Essential for diagnosing acute coronary syndrome and evaluating ventricular function 4
• Useful for ruling out other etiologies including aortic dissection and pericardial effusion 4
• Allows immediate diagnosis of pericardial effusions and cardiac tamponade 5

Sample Prescription Format

Procedure: Transthoracic Echocardiogram (2D Echo with Doppler)

Diagnosis Code(s): I10 (Essential hypertension), R94.31 (Abnormal ECG)

Clinical Indication: Assessment for hypertension-mediated cardiac damage; evaluation of left ventricular hypertrophy seen on ECG

Relevant History: 45-year-old with uncontrolled hypertension on triple therapy, BP 165/95 mmHg, ECG shows LVH

Specific Requests: Evaluate LV mass, chamber dimensions, systolic and diastolic function, valvular function

Important Considerations

Avoid Common Pitfalls

• Do not use I11.9 (Hypertensive heart disease without heart failure) unless there is documented evidence of hypertensive heart disease on prior testing 1
• Avoid "unspecified" codes when more specific information is available from the clinical encounter 1
• Do not delay ordering the test if clinically indicated—I10 alone is sufficient for ordering as part of initial evaluation or when assessing for target organ damage 1

Quality Standards

• The examination should be performed with appropriate equipment and supervised by an experienced echocardiographer 6
• Studies should be recorded in dynamic video or digital format for future review and comparison 6
• Sedation may be needed for uncooperative patients, particularly those <3 years of age 6