# Tee done during cabg



## nlaaron (Oct 7, 2013)

Can anyone tell me why its okay to bill for A-lines, Swanz-Ganz, but not for a TEE during a CABG, unless for a specific diagnosis?? Aren't the line just for monitoring as well and considered an integral part of the procedure??  To me, it seems like, if we can bill for the lines, we should be able to bill for the TEE. Anyone have any comments?? Id appreciate any opinions and especially facts, perhaps from the AMA. ( I don't have a membership to submit a questiont to the AMA, or else I would do so) Thanks.


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## cbaldia (Oct 10, 2013)

If you are referring to the anesthesiologist billing for a-lines or swan ganz lines in addition to the anesthetic, they are billing for the actual INSERTION OF THE LINES as a procedure, NOT for the monitoring- codes state "catheterization or insertion of."  (they wouldn't bill the codes if the lines were in situ and they just hooked them up to the monitors would they?)
There are multiple TEE codes, if you are billing the diagnostic TEE codes(93312,93315)- there are dx to procedure LCDs for CMS because it is NOT monitoring but Diagnostic and they need medical necessity to be covered. Why was the procedure necessary- what is wrong with the patient- signs/symptoms to justify the TEE?  If the anesthesiologist is using the TEE only for monitoring (CPT 93318)- it is bundled into EVERY Anesthesia CPT code by CCI. Part of the job of the anesthesiologist is to monitor the patient, regardless of techniques i.e. pulse ox, BIS monitor, arterial line monitor, or TEE monitor. 

You need to make sure your providers are documenting appropriately and reporting the appropriate CPT code for the TEEs.

Hope this helps.


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## Davieda Skobel (Jun 4, 2014)

*TEE with CABG*

I am having the same problem with billing TEE's.We do anesthesia for the CABG and I believe we are placing the TEE probe and monitoring the patient. Has anyone out there found a way to bill and collect for these?

HELP!!!

Davie


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## hgolfos (Jun 5, 2014)

Davie, 

TEE's for routine intra-operative monitoring (93318) are not separately billable.  If your provider is placing the probe (93313 & 93316) or providing interpretation and report as well (93312 & 93315) *for diagnostic reasons*, you should report the final diagnosis from the TEE report, for example 

93312-26 (includes probe placement, interpretation and report)
424.0 mitral valve insufficiency

Be careful, and advise your providers that the documentation should include:

A formal report
A permanent image stored in the medical record
Medical necessity for the procedure.

Hope this helps,

H. Golfos, CPC, CANPC


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## LeslieJ (Jun 10, 2014)

*TEE with CABG*

H Golfos & Cbaldia gave you excellent information, but forgot a couple of teeny tiny details:

The TEE codes, such as 93312-26 require modifier 59 in order to pull this code out from CCI Bundling.  As a _diagnostic procedure_, there should also be a separate report from your physicians that include indication and findings, if any.  Here's a sample if you need one if you need an idea: www.scahq.org/files/TEEREPORfin4-02.rtf

You can find this information within the CCI Edits policy manual for Medicare services here: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip  Once you open this zipped item, select the Anesthesia chapter (2) and do a quick search on 93312.  Everything that H. Golfos, cbaldia & I have said will be there & then some.  There's great information in there!

Also, pay attention to your Medicare carrier's LCD to make sure that the diagnoses provided are listed in the LCD.  If they're not, this may make it difficult to get reimbursed.

Absolutely TEE can be charged and paid for if the coding & documentation are correct.

Good luck!

Leslie Johnson, CPC


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