TEE was performed first in the cath lab because the provider knew going into the TEE that he will need to do Fluoroscopy.

I am unsure if i would bill it because when I think of Fluoroscopy i feel that it falls under image and guidance procedure and with a TEE imaging and guidance is included with the TEE CPT code.

Scenario: Provider knows going into the TEE that he will need to do Fluoroscopy.

CONCLUSION OF THE TEE:
Normal LV systolic function and wall motion with EF 60%.
Mild MR.
The bileaflet mechanical aortic valve prosthesis has leaflets that are somewhat difficult to visualize, but at least the more posterior leaflet appears to be moving normally. There is a very eccentric jet of paravalvular aortic insufficiency that arises posteriorly and tracks directly across the LVOT just under the valve and is at least moderate to severe. It is brought in the LVOT but does not penetrate deep into the ventricle, possibly because of its eccentricity. I can’t completely rule out that there might also be some valvular AI coming through the more anterior leaflet, but I think this appearance is caused by deflection of the eccentric paravalvular jet under the valve. I also note that there is a thin, echogenic rigid appearing structure above the valve posteriorly in the noncoronary sinus of Valsalva, which may represent a line of pannus ingrowth, suture, or some other structure. It looks almost like a strut of a bioprosthetic valve, but this is a strutless mechanical valve.
Trace TR.
Mild pulmonic insufficiency.
No patent foramen ovale.
No left atrial appendage thrombus.
Mild intimal thickening of the descending thoracic aorta.
Mildly dilated mid ascending aorta measuring 4.1 cm in diameter.

Thank you