The most common problem in anesthesia coding associated with billing and obtaining reimbursement for transesophageal echocardiography or TEE is determining whether the procedure is for diagnostic or monitoring purposes. It is often difficult to tell whether the TEE was diagnostic or not unless your physician identifies the study’s purpose. If you wish to bill for a diagnostic TEE, attach a written report, or else it’s unlikely to withstand the scrutiny of an audit.
CPT contains two sets of codes for diagnostic transesophageal echocardiography or TEE. For a diagnostic test, pay attention to whether the anesthesiologist places the probe, interprets and reviews the study, or provides both services. When your anesthesiologist places the probe and does not provide a written report, use the placement-only diagnostic TEE codes. Your physician sometimes might interpret the findings while another physician places the probe. Provided your anesthesiologist is the only physician to issue a written report of the diagnostic TEE, you would code for the “image acquisition, interpretation and report” only with 93314 for real-time TEE and 93316 for TEE for congenital cardiac anomalies.
Avoid truncated diagnosis codes in anesthesia coding. Make sure your anesthesiologist is as specific as possible when reporting diagnoses attached to TEE use. Merely linking the TEE code to a payable ICD-9 code is not sufficient. Clinical signs or symptoms must be present and documented.
Transesophageal echocardiography for monitoring is never paid nor is it ever unbundled. When TEE is used in dissection or with valvular repair, your anesthesiologist is diagnosing whether surgery fixed the lesion. Your anesthesiologist is then not monitoring, but telling the surgeon whether his repair has corrected the problem to an acceptable level. Here, he is playing an active role in management and doing more than just monitoring. If you include a full report in this case, you can bill a reimbursable code like 93312 or 93314, but make sure you do not label this report as monitoring, else you’ll not be entitled to reimbursement.
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